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Nasolacrimal Duct Obstruction

Nasolacrimal Duct Obstruction

What is a tear duct obstruction?naso

Tears normally drain through small openings in the corners of the upper and lower eyelids called puncta and enter the nose through the nasolacrimal duct. Tear duct obstruction prevents tears from draining through this system normally [See figure 1].

What causes nasolacrimal duct obstruction in children?

The most common cause is the failure of a membrane at the end of the tear duct (valve of Hasner) to open normally at or near the time of birth.
Other causes of blocked tear ducts in children include:

  • Absent punctum (upper and/or lower eyelid)
  • Infection
  • Nasal bone that obstructs the tear duct entering the nose.

How common is nasolacrimal duct obstruction?

Over 5% of infants have symptoms of nasolacrimal duct obstruction affecting one or both eyes. Over 90% clear spontaneously during the first year of life.

What are the signs/symptoms of tear duct obstruction?

Blockage of the drainage system causes tears to well up on the surface of the eye and overflow onto the eyelashes, eyelids, and down the cheek. This usually occurs within the first days or weeks of life.

The eyelids can become red and swollen (sometimes stuck together) with yellowish-green discharge when normal eyelid bacteria are not properly “flushed” down the obstructed system. Severe cases result in a serious infection of the tear duct system (dacryocystitis).

How is tear duct obstruction diagnosed?

A history of watering and discharge from the eyes at a very early age is strongly suggestive of a blocked tear duct. Diagnosis is done by the ophthalmologist by doing some in office tests. It is important to examine the eyes for other important causes of watering such as conjunctivitis and congenital Glaucoma.

What is the treatment of a blocked tear duct?

Commonly, tear duct obstruction resolves spontaneously in majority of cases. When obstruction is persistent, one or more of the following treatments may be recommended: tear duct massage, topical antibiotic eye drops, tear duct probing, balloon tear duct dilation, and/or tear duct intubation.

How does tear duct massage work?

Tear duct massage helps to open the tear duct. A pediatric ophthalmologist can demonstrate the most effective massage technique. 80% of children are treated just by doing the massage and probing or surgery can be avoided.

When should topical antibiotics be used?

Antibiotic eye drops or ointment may be used to treat discharge or mattering around the eye. The medication does not open the blocked tear duct and symptoms often recur when the eye drops are discontinued.

When should tear duct probing be performed?

If the tear duct remains blocked, a nasolacrimal duct probing may be performed. Probing is most effective when child is around 1 year of age. The older the child gets the lesser the chance that probing may work.

How does tear duct probing work?

A smooth probe (resembling a thin straight wire) is gently passed through the tear duct and into the nose. Using probes of progressively larger diameters can widen a tear duct system.

How successful is tear duct probing?

Tear duct probing is generally very successful. Over 90% of children have resolution of symptoms after the procedure. Sometimes additional procedures with enhancements are necessary. In rare cases, a more involved operation may be needed to open the tear duct system (dacryocystorhinostomy, DCR).

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