Lacrimal System

Lacrimal (Tear Duct) System

The lacrimal system is made up of the lacrimal gland that produces tears, and the “duct” that drains tears from the eye into the nose. The most common symptoms of lacrimal system problems are excess tearing (to the point that tears might run down the face) and mucous discharge.

Having a plugged tear duct can lead to more serious issues than tears spilling over the eyelids and running down the face. Stagnant tears within the system can become infected and cause recurrent red eyes and infections. Excessive tearing can also produce secondary skin changes on the lower eyelids.

Congenital Nasolacrimal Duct Obstruction

Nasolacrimal duct obstruction (NLDO) is very common in infants. In fact, 6 percent of all children are born before their tear ducts open, which means they have a tear duct obstruction. Most of these children have no problems because the tear ducts open spontaneously.

If the ducts do not open quickly, however, stagnant tears within the tear duct can become infected and cause pus to collect between the eyelids. Antibiotics might help some of the symptoms, but don’t cure the blockage.

Most obstructions resolve on their own within the child’s first few months of life. Approximately 95 percent of children with tear duct blockages show resolution before their first birthday. Using antibiotics and massaging the infected, blocked tear duct might help the duct open.

If the blockage does not resolve naturally, surgery may be necessary. A probing procedure might be done if the duct remains blocked after the baby is six months to one year old. Surgical probing (done on an outpatient basis) successfully opens the blocked duct for about 90 out of 100 babies. Newer techniques, including balloon dacryoplasty (balloon dilation of the tear ducts), have improved the success rate of treating blocked tear ducts.

Treatment of Adult Tear Duct Blockage

Surgery is usually required when the nasolacrimal duct (the tube that drains tears into the nose) is blocked. A physician may attempt to widen the opening by flushing water through the duct when it is only partially blocked. Eye drops with anti-inflammatory and antibiotic medications will then be prescribed to help reduce swelling in the duct and promote tear drainage.

These simple attempts to open the tear duct aren’t often successful and might need to be repeated periodically. Surgery could be necessary.

Surgical therapy can be more complicated when the tubes that drain the tears into the lacrimal sac (called the canaliculi) are blocked. The surgeon will reconstruct the canaliculi in most cases.

Eyelid weakness or malposition can be treated surgically by tightening and repositioning the lids.

Balloon Dacryoplasty

A procedure known as balloon dacroplasty might be used to unstop blocked tear ducts. During this outpatient procedure, the surgeon dilates the tear duct system with a high-pressure, specially-designed balloon probe. He or she inserts the probe into the tear duct, and a process of inflation and deflation opens the system without any cutting. The success rate for balloon dacryoplasty is well over 90 percent when done along with placing small, temporary silastic stents.

Dacryocystorhinostomy (DCR)

DCR (dacryocystorhinostomy) is a same-day procedure that creates an opening in the bone between the blocked tear sac and the nose. The lining of the tear sac is then attached to the lining of the nose to form a permanent drainage channel for tears.

For most people, the surgeon places a clear plastic tube from the inside corner of the eye into the nose. The tube helps stent the tear drainage system and prevents scarring. It is easily removed in the physician’s office four to six months later. Additional treatment with anti-scarring drugs may be used within the surgical opening to improve the procedure’s success rate.

You may choose to either be asleep under general anesthesia or awake with IV sedation during the procedure.

After surgery, the physician places sutures in the skin; they usually dissolve in one to two weeks. The resulting scar might initially be red, hard, and raised, but will smooth out during the following weeks and months.

Surgeons can also perform a DCR through the nose, which is known as an endoscopic DCR. This approach avoids making a skin incision. However, the success rate with endoscopic DCR is probably less than when the procedure is performed through the skin because the tear sac is not directly attached to the lining inside the nose.