Nasolacrimal Duct Obstruction

Failure of the thin tissue at the end of the tear duct to open normally is the most common cause. In adults, a blocked tear duct may be due to an injury, infection or a tumor. (Blocked tear ducts are very common in newborns, but they usually get better without any treatment during the first year of life.)

Blocked tear ducts can happen at any age.

• Congenital blockage. Many infants are born with a blocked tear duct that usually opens spontaneously during the first or second month of life.
• Age-related changes. As you age, the punctal openings (tiny drainage holes at the corner of your lid) may narrow and cause partial blockage that slows the flow of tears into the nose, resulting in tearing. Total blockage of the punctal openings also may occur.
• Eye infections or inflammation. Chronic eye infections and inflammation in the tear drainage system or nose can cause tear ducts to become blocked.
• Facial injuries or trauma. An injury to your face can cause bone damage near the drainage system, disrupting the normal flow of tears through the ducts.
• Tumors. Nasal, sinus or lacrimal sac tumors can grow along the tear drainage system and block the duct.
• Topical medications. Rarely, long-term use of certain topical medications—such as some of those that treat glaucoma—can cause a blocked tear duct.
• Cancer treatments. A blocked tear duct is a possible side effect of chemotherapy medication and radiation treatment for cancer.

Symptoms of nasolacrimal duct obstruction often affect only one eye and include:

• Constant and severe tearing
• Painful swelling near the inside corner of the eye
• Recurrent eye inflammation (conjunctivitis) or tear duct infections (dacryocystitis)
• Mucus or pus discharge from the lids and surface of the eye
• Blurred vision

You should consult with an otolaryngologist if your eye is constantly watery and continually irritated or infected. In rare cases, blocked tear ducts are caused by tumors pressing on the tear drainage system for which immediate treatment is necessary.

Tests to diagnose a blocked tear duct include:

• Tear drainage test. Called a dye disappearance test, this test measures how quickly your tears are draining. One drop of a special dye is placed in each eye. If there's still a significant amount of dye in your eye after five minutes of normal blinking, you may have a blocked tear duct.
• Irrigation and probing. Your doctor may flush a saline solution through your tear drainage system to check how it's draining, or use a slender instrument (probe) inserted through the tiny drainage holes at the corner of your lid (puncta) to check for blockages.
• Eye imaging tests. For these procedures, a contrast dye is passed from the puncta in the corner of your lid through your tear drainage system. Then, X-ray, computerized tomography (CT-scan) or magnetic resonance imaging (MRI) images are taken to find the location and cause of the blockage.

Your otolaryngologist will work with you to determine which treatment is right for your specific condition.

• For infections, antibiotic eye drops are typically recommended.
• For a facial injury causing a blocked eye duct, your tear ducts may become unblocked on their own, usually within a few months.
• If a tumor is suspected, treatment will focus on the cause of the tumor.
• For non-tumor-blocked tear ducts, there are minimally invasive treatments such as:
  • Dilation, probing and irrigation
  • Balloon catheter dilation
  • Stenting or intubation
• Surgical treatment called a dacryocystorhinostomy can be performed to create a new, direct connection between your lacrimal sac and your nose. This new route bypasses the duct that empties into your nose (nasolacrimal duct), which is the most common site of blockage. Stents or intubations are usually placed in the new route while healing occurs, and they are usually removed about three months after surgery.

You will receive a thorough diagnostic examination to evaluate if you have a nasolacrimal duct obstruction and determine what course of treatment is needed. Careful monitoring and the involvement of an experienced otolaryngologist are important to the successful outcome for patients with ear, nose and throat disorders and conditions.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be taken care of in the operating room by otolaryngologist, anesthesiologists and nurses who specialize in surgery for patients with nasolacrimal duct obstructions. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by experienced surgical and nursing staff.

Brigham and Women’s Faulkner Hospital provides a multidisciplinary approach to patient care by collaborating with colleagues who have extensive experience in diagnosing and treating ear, nose and throat disorders and conditions. In addition, patients have full access to Brigham and Women's Hospital's world-renowned academic medical community, with its diverse specialists, and state-of-the-art facilities.