The treatment of lacrimal
duct obstruction (epiphora)
What is lacrimal duct obstruction?
Tears are produced by the lacrimal gland, located in the upper part of the eye socket. With each blink, the produced tears spread across the surface of the eye, and the excess tears are drained out of the eye by the tear drainage system and directed into the nasal cavity. If you look closely at the inner corner of your eye, you can see very fine openings on the edges of both the upper and lower eyelids, which are the entry points for tears into the tear drainage system. These fine openings connect to the lacrimal sac, located under the inner corner of the eye, and from there, the tears enter the nasal-tear duct (commonly known as the nasolacrimal duct) and are eventually drained into the nasal passage. This is why we experience a runny nose when we cry. Therefore, the tear drainage system consists of the main and accessory lacrimal glands, tear ducts, the lacrimal sac, and the nasolacrimal duct.
Symptoms of Lacrimal Duct Obstruction
Patients with tear duct blockage typically complain of constant or occasional tearing and the discharge of pus from the inner corner of the eye to the ophthalmologist. In these patients, the eye’s tears chronically and continuously flow over the face, forcing them to use a tissue to dry the eye, even when they are resting at home. In cases of prolonged tear duct obstruction, sometimes an infection and acute inflammation of the lacrimal sac occur. This condition manifests as a swollen, firm, red, and very painful area in the inner corner of the eye, between the eye and the nose, requiring urgent treatment and sometimes hospitalization.
Tear Duct Obstruction in Children and Infants and Its Treatment
Tear duct obstruction in children and infants is a common occurrence. It’s observed in full-term newborns in about 5% of cases and in premature infants, it can be seen in up to 30% of cases at birth. These children usually spontaneously recover by the age of 8 to 9 months in 90% of cases, and if they don’t, after this age, a tear duct probing (milking) is performed. If probing is done under the age of one year, the success rate is over 90%, and the older the child is at the time of probing, the lower the success rate. In children over one year old, probing is typically performed 1 to 2 times, and if it’s not successful, a special silicone tube called a “crawford” may be inserted into the tear duct, which remains in place for up to one year and is then removed. In children over 4 to 5 years old, surgery called dacryocystorhinostomy (DCR) is usually needed, along with the insertion of a silicone tube.
Obstruction of tear ducts in adults and treatment
Tear duct obstruction is treatable by probing (or milking) the tear duct in children under the age of two to three years. However, in older children and adults, probing is only for diagnostic purposes and is not recommended for treatment. In adults, a procedure called dacryocystorhinostomy (DCR) is performed, during which the tear duct is opened into the nose. If the upper part of the duct is blocked, silicone tubes are placed in addition to DCR for several months. But if the lower part is blocked, only DCR is necessary.