When an obstruction occurs in the duct system which carries tears away from the
surface of the eye to the nose, it is called a blocked tear duct or nasolacrimal
duct obstruction.
What Causes a Blocked Tear Duct?
Tears are produced in the lacrimal gland located above the lateral aspect of the
eye. These tears are secreted and travel across the cornea, exiting via the superior
and inferior puncta (holes) on the inner (medial) corner of the eye. Usually, a
small tube called the nasolacriminal duct drains the tears from the surface of the
eye into the nose. This duct is usually developed by birth but up to 1% to 5% of
the population may have a duct that is incompletely developed or obstructed. The
nasolacrimal duct has three valves in it and the majority of nasolacrimal duct obstructions
occur at the most distal valve that is located in the nose (Hasner's Valve).
Who gets a Blocked Tear Duct?
Babies begin to produce tears at two days to two weeks after birth. You may notice
excessive tearing from one or both of your infants' eyes during this time. Rarely,
adults get a blocked tear duct because of an infection, an injury, or a tumor.
What are the Symptoms of a Blocked Tear Duct?
The main symptom of a blocked tear duct is increased or excessive tearing.
How is a Blocked Tear Duct Diagnosed?
A blocked tear duct is diagnosed after a standard eye exam or an internal examination
of the nose. If necessary, the drainage of the tears can be tracked by an eye stain.
How is a Blocked Tear Duct Treated?
Nearly half of the cases of nasolacrimal duct obstruction will resolve spontaneously
by 6 months of age. A pediatric ophthalmologist may need to probe your childs eye
between 6 to 12 months of age to help open up the obstruction. In rare circumstances,
the probing does not fix the problem completely and a silicone stint may have to
be placed in the nasolacrimal duct for 1 to 3 months to help keep the duct open.
In the meantime, your health care provider may choose to prescribe antibiotic drops
or ointment if your child has persistent yellow drainage from the eye. Some health
care providers recommend a massage technique to try to unblock the duct. Two methods
have been recommended. You may place a washed finger between the nose and the inner
corner of the eye. Massage downward (inferiorly) in an attempt to push the tears
through the nasolacrimal duct via its normal path. Another recommendation calls
for a superior motion in the same location, pushing the tears out of the duct. You
should do this procedure at every other feeding for a newborn.
What are the Complications of a Blocked Tear Duct?
A blocked tear duct can cause a significantly higher amount of eye infections resulting
in yellow discharge from the eye. These infections can be treated by antibiotic
eye drops or ointment.
Rarely, your child may develop a bluish swelling on the skin between the nose and
the inner corner of the eye(an amniotecele). Massage may be attempted. However,
if the swollen area becomes red and inflamed, you should contact your health care
provider immediately for an abscess may be developing which requires IV antibiotics
and probing.
References
Nelson LB, Calhoun LJ, Menduke H. Medical Management of congenital nasolacrimal
duct obstruction. Pediatrics 76: 173 1985
Wright, KW. Pediatric Ophthalmology for Primary Care, 2003, American Academy of
Pediatrics
Reviewed by: Evan Taragano MD
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