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Nasolacrimal Duct Obstruction

Nasolacrimal duct obstruction – NLDO​

When you have a blocked tear duct, your tears can’t drain normally, leaving you with a watery, irritated eye. The condition is caused by a partial or complete obstruction in the tear drainage system.

A blocked tear duct is common in newborns. The condition usually gets better without any treatment during the first year of life. In adults a blocked tear duct may be due to an injury, an infection or a tumor.

A blocked tear duct is almost always correctable. Treatment depends on the cause of the blockage and the age of the affected person.

Symptoms

Signs and symptoms of a blocked tear duct include:

  • Excessive tearing
  • Redness of the white part of the eye
  • Recurrent eye infection or inflammation (pink eye)
  • Painful swelling near the inside corner of the eye
  • Crusting of the eyelids
  • Mucus or pus discharge from the lids and surface of the eye
  • Blurred vision

Frequently Asked Questions

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.

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.

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.

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).

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.

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.

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.

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.

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.

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.

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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