An obstructed tear duct is a very annoying, although benign, condition that affects many individuals around the world. The main symptom of an obstruction is constant tearing from an eye or watery eyes. Granted, not all teary eyes are due to an obstruction. In fact, the most common cause of watery eyes is dry eye syndrome! This may sound contradictory, but there is a good reason why dryness causes tearing. A dry eye is always irritated and this irritation causes reflex tearing and watery eyes.
For those cases of a true obstruction, which can affect a persons’ quality of life, there is a very effective and safe treatment that can change their lives. In today’s blog, we will spend some time reviewing the cause of tear duct obstruction and how to treat it.
Some words about the tear system of the eye
Tears are made in a gland that is located under the upper eyelids, called the lacrimal gland. The tears then lubricate and protect the surface of the eyes. After wetting the cornea, the tears drain through a system that starts in the eyelids. Small canals called canaliculi take the tears to a sac by the pumping action of the eyelids during each blink. After reaching the tear sac, the tears travel down a duct called the nasolacrimal duct which finally takes them to the nose and then to the throat. This explains why we can taste eye drops and why our noses get stuffy when we cry.
Causes of an obstruction in the tear duct and how to treat them
An obstructed tear duct can be seen in newborns, middle age adults and the elderly, although the causes are different for every age group.
In babies, the obstruction is usually located in the nose, in a valve that has failed to open. This causes tearing and a chronic infection of the affected eye. Fortunately, most of these obstructions resolve on their own as the valve opens by one year of age. However, if it fails to open, the surgeon will have to open the valve in the operating room.
In middle age adults, the tear duct system may be obstructed by a stone in the small ducts in the eyelids (canaliculi) that take the tears to the sac. This creates a painful infection in the corner of the eye, called canaliculitis, manifested by discharge form the eye and a red bump. The treatment is always surgical and involves making a cut in the small ducts and removing the stones. This restores patency of the system and the tears can drain easily into the sac.
In older adults, the obstruction in most commonly found in the nasolacrimal duct, the duct that connects the tear sac to the nose. This is more common in females. The clinical result is constant tearing which travels down the cheek and the patient has to blot with a tissue. The second effect is that the tear duct can become infected and cause an abscess, called acute dacryocistitis. This is an extremely painful condition in which a large bump forms in the inner corner of the eye. Treatment is with hot compresses and oral antibiotics. Other patients don’t experience an acute abscess of the sac but, instead, a chronic infection which manifests as constant tearing and discharge of pus from the eye, usually in the morning.
Endoscopic DCR for obstructed tear ducts
The only effective treatment for a tear duct obstruction is an operation called DCR. This surgery creates a passage from the tear duct to the nose in order to bypass the obstruction of the duct. Tears and mucous material can drain directedly to the nose without problems; that is, the tears can travel to their normal destination without reflux through the eyelid.
A DCR is an outpatient procedure that is done with general anesthesia. The operation can be performed though an incision in the skin (external) or via the nose (endoscopic). The endoscopic route is more advantageous for several reasons. The first reason is that an incision in the skin is avoided, so there is no risk of creating a scar. Another reason is that the recovery time is shorter and less painful for the patient. Finally, endoscopic DCR seems to have a higher success rate than the external route. The operation takes about 45 minutes and the recovery is very easy for the patient. There is very minimal discomfort after the procedure.
Tear duct surgery in Costa Rica
Tear duct surgery is performed by specialists in the lacrimal system called oculoplastic surgeons. These surgeons have ample experience in endoscopic techniques to treat tear duct obstructions.
You do not have to live with your symptoms any longer!
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