Blocked Tear Ducts- Causes, Symptoms, Management, and Prevention

Introduction

Blocked tear ducts are also called nasolacrimal duct obstructions. This obstruction occurs in the valve of Hasner at the distal end of the duct. As a result, eyes may become irritated, itchy, and watery. These ducts form at the corners of the eye and connect the bones of the face and the nose. When there is obstruction, tears cannot drain from the eyes; instead, tears stay in the eyes and make the eyes watery and can lead to infection. Congenital nasolacrimal duct obstruction is seen in five percent of infants. There is no genetic predisposition. Almost 90 % of nasolacrimal duct obstruction is resolved within the first year of life. When conservative methods fail to remove the obstruction, a surgical procedure is performed to relieve the obstruction.

What Are the Causes of Blocked Tear Ducts?

• Older age can lead to narrowing of the puncta (minute opening a present on the margins of eyelids at the lateral extremity and help to collect tears).

• Congenital blockage.

• Narrow tear ducts.

• Severe eye infections or sinus infections.

• Tumors or polyps (small polyps) in the nose.

• Nasal allergies.

• An injury in an eye.

• History of chemotherapy or radiotherapy.

• Uveitis is inflammation of the eye.

• Patients with down syndrome have nasal deformities.

• Glaucoma (a condition that damages the optic nerve).

• Conjunctivitis (pink eye, when conjunctiva gets inflamed).

• Viral infections.

• Deviated nasal septum.

• Trauma cuts the drainage ducts.

What Are the Symptoms of Blocked Tear Ducts?

• Loss of visual acuity (the ability of eyes to distinguish shape and details).

• Watery, itchy eyes.

• Epiphora (excessive tears).

• Fever.

• Redness.

• Mucous or pus discharge.

• Crusting around the eyes.

• Swelling near the inner corner of the eye.

• Dacryocystitis occurs because of nasolacrimal duct obstruction. It is characterized by painful, red, swollen nodules over the tear duct. This is a medical emergency that requires antibiotics and hospitalization.

• Dacryocele is a bluish nodule over the tear duct seen in infants. Nasal endoscopy with cyst removal is done to manage the condition.

What Are the Risk Factors?

• Sex: Females are more prone to nasolacrimal duct obstruction.

• Smoking: Tobacco smoking can also predispose to blocked tear ducts.

• Swimming: Swimming in chlorinated water.

How Can We Diagnose a Blocked Tear Duct?

• Tear Drainage Test: If tears do not flow from your eyes, you may have blocked tear ducts.

• Fluorescein Dye Test: There is a disappearance of fluorescein dye, which can help confirm the diagnosis of obstruction of the lacrimal duct. It is useful when the unilateral eye is involved.

• Eye Imaging: Computed tomography (CT) scan, magnetic resonance imaging (MRI), and X-Ray can be done to find the location and cause of blocked tear ducts.

• Probing: An instrument can be used to probe the blocked tear duct.

How to Manage Blocked Tear Ducts?

• Massage: Firm pressure can be used in a downward motion; builts hydrostatic pressure causes mucus reflux and tears through the puncta.

• Hygiene: Cleaning of the eyelids is done to prevent blocked tear ducts.

• Antibiotics: Oral antibiotics or eye drops can be given in case of an eye infection.

• Dilation, Probing, and Flushing: It can be performed to remove the obstruction. Dilation of puncta is done with the help of a probe, and after that, flushing of the tear duct is performed. This procedure provides temporary relief.

• Stenting: Stenting is performed under general anesthesia. The hollow tube is placed through the puncta into the tear duct. This duct helps drain the tears properly and is placed for around three months. Complications can arise because of the presence of hollow tubes placed through the puncta.

• Balloon Catheter Dilation: A catheter is inserted into the tear duct. A pump inflates the tube, then the doctor deflates or inflates the balloon repeatedly to widen the duct.

• Dacryocystorhinostomy: Outpatient surgery is done to bypass the blocked tear duct. Connection is made between the lacrimal sac and the nasal cavity, and a stent is placed for three to four months to open the new route to drain tears into your nose. Dacryocystorhinostomy relieves tear duct obstruction. There are a few side effects, such as infection, scars, stuffy nose, and bruises.

Surgery can be performed in the following ways.

1. External: Small cut is made on the side of the nose and is closed with the help of stitches.

2. Internal: The camera and instrument are inserted through the opening of the nose. This type of surgery causes less pain and scars.

3. Snip Punctoplasty: Incisions are given on the puncta to create a larger tear duct opening. This procedure is used for partial obstruction.

How to Prevent a Blocked Tear Duct?

• Avoid sharing cosmetics or eye drops.

• Avoid rubbing your eyes.

• Wash your hands thoroughly.

• Replace your cosmetics after every three months.

• Use clean contact lenses.

• In mild cases, it is recommended to do warm compresses.

• Proper treatment of nasal infections and conjunctivitis may reduce the risk.

What Is the Differential Diagnosis?

Differential diagnosis includes:

• Conjunctivitis (inflammation of the conjunctiva).

• Corneal abrasion (rubbing of the cornea).

• Uveitis hemangiomas (non-cancerous overgrowth of blood vessels in the retina).

• Dermoids (growth of normal tissue).

• Nasal gliomas (rare congenital midline tumors).

• Infantile glaucoma (glaucoma seen in the first few years of life).

Conclusion

Nasolacrimal duct obstruction occurs when nasal passages cannot drain liquid properly from the eyes. Clogged tear ducts make the eyes uncomfortable, causing itchiness in the eyes. When the drainage system gets blocked, it causes pain and decreased visual acuity and increases the risk of infection. In addition, it may cause watery or irritated eyes. Nasolacrimal duct obstruction causes mucus discharge with systemic illnesses such as fever and malaise. Typically, obstruction presents in the first weeks or months of life. Blocked tear ducts are seen mainly in infants and get cured independently. However, it usually requires treatment in adults, with an almost 90 % success rate.