What is Dacryostenosis (Blocked Tear Duct)?

Dacryostenosis is a medical condition which comes from having a blockage in your tear duct, also known as nasolacrimal duct obstruction (NLDO). This can cause your eyes to water excessively. The name dacryostenosis comes from the Greek words for “tear” and “narrowing”, which reflects what happens in this condition – there’s a kind of narrowing or blockage in the tear duct that we are born with or that we develop later in life.

Your tear glands make tears to keep the surface of your eyeballs moist. Once they have done their job, these tears move to your nose via the tear duct. Your tears are crucial in keeping your eyes healthy, and for that reason, understanding how your tears are produced and how they leave your eyes is very important, especially when it comes to conditions like dacryostenosis.

The system that removes tears from your eyes to your nose is made up of four parts. These include:

  1. The puncta: Small openings found on your eyelids
  2. The canaliculi: Tiny channels connecting the puncta with a bag-like structure called the nasolacrimal sac
  3. The nasolacrimal sac: This acts like a storage for the extra tears that we produce
  4. The tear duct itself: This carries tears from your eyes into your nose

One condition associated with dacryostenosis is Epiphora. It is a condition that can cause your eyes to water excessively when there’s a problem with any part of your tear removal system.

About 6% of all infants have a form of dacryostenosis from birth which is the most common reason for persistent tearing and discharge from the eye. This is usually due to an abnormal formation of the tear duct while the baby is still developing in the womb.

Dacryostenosis can also develop later in life, which is known as acquired dacryostenosis. This type can occur due to various reasons such as swelling, fiber-like tissue formation, fluid build-up, blocked blood vessels, slow blood flow, infections, or injuries to the tear gland, which can then cause a partial or complete blockage of the tear duct. Hormonal changes during menstrual cycles, weakening bones, particularly in women older than 40 and the gradual narrowing of the tear duct could make someone more prone to develop this condition in adulthood. Other potential causes include infections, inflammation, tumors, and physical obstructions.

The two main symptoms of dacryostenosis are persistent tearing and a mucus-like discharge from your eyes. They typically occur in newborns in the first weeks to months of life. Although usually harmless in and of itself, untreated dacryostenosis can lead to more serious issues like frequent eye infections, staining of tears, conjunctivitis, an infection of the tear sac, and even potentially life-threatening ones like swelling of the eye area, blood poisoning, meningitis (an infection of the protective membranes that cover the brain and spinal cord), or brain abscess. For these reasons, early management of dacryostenosis is key to prevent serious medical problems.

What Causes Dacryostenosis (Blocked Tear Duct)?

Dacryostenosis, a condition where the tear ducts narrow or become blocked, can happen due to many factors. It can be something a person is born with, or it can develop due to other issues such as infections, inflammation, medicine, or harm to the tear system.

Congenital Dacryostenosis

This type usually occurs randomly at birth, but recent studies indicate that genetics could play a part in its development. Certain changes in genes can affect the formation of the tear system and could potentially link to other syndromes that a child is born with. Also, babies born prematurely or to mothers who used drugs may have a higher risk of having this condition.

Acquired Dacryostenosis

This form of dacryostenosis isn’t fully understood and can occur due to many factors. Although most cases have no apparent cause, possible underlying issues could include trauma, tumors, certain diseases, exposure to radiotherapy, and chemotherapy.

Primary Acquired Dacryostenosis

PANDO refers to conditions involving the tear gland’s drainage system, typically caused by inflammation, fibrosis, swelling of the mucous membrane, vascular congestion, infection or injury to the tear apparatus. These factors can lead to a partial or complete blockage of the duct later in life.

Some experts suggest that PANDO is primarily due to narrowing of the bony tear duct that happens due to aging. This duct tends to be smaller in females and narrows over time, further narrowing with osteoporotic changes. Hormonal changes during menstruation may cause an obstruction due to debris shedding.

Chronic inflammation can also cause changes in the surrounding blood vessels of the tear sac and fibrosis of the nearby connective tissue fibers. This inflammation can cause swelling of the mucous membrane and other anatomical changes, increasing the likelihood of a temporary blockage of the tear passage.

Secondary Acquired Dacryostenosis

SANDO can be caused by several issues such as infection, inflammation, tumors, trauma, and mechanical disorders.

Infections: Dacryocystitis, an infection of the tear sac, is the most common infectious cause of SANDO, typically involving bacteria like Staphylococcus, Streptococcus, and Actinomyces.

Inflammation: Conditions like granulomatosis, sarcoidosis, and others, as well as certain treatments, can lead to inflammatory causes of NLDO.

Neoplasm: Tumors causing NLDO can be original tumors, secondary spread, or metastatic disease. These can come from various sources, including eyelid carcinomas and maxillary tumors.

Trauma: Traumatic causes of NLDO can result from things like fractures, facial trauma, accidents, delayed treatment of facial fractures, and complications from certain surgeries or procedures.

Mechanical disorders: Obstruction of the nasolacrimal duct can occur due to foreign bodies such as dacryoliths or rhinoliths, or abnormalities like nasal foreign bodies or mucoceles. Infections and long-term use of certain topical medications can also lead to disruption of the normal flow of tears.

Risk Factors and Frequency for Dacryostenosis (Blocked Tear Duct)

Congenital dacryostenosis, a condition affecting the eye’s tear-drainage system, is fairly common, affecting around 6% of all newborns. It’s the main reason for constant tearing and eye discharge in infants and is caused by abnormal eye development in the womb. Interestingly, about 20% of healthy infants face some issues with their tear-drainage system during their first year.

This condition has been observed to occur more often in premature infants and those with Down syndrome, with rates of 16% and between 22% to 36%, respectively. It’s also more common among infants delivered by cesarean section. In addition, around 10% of newborns with this condition also show uneven vision between their two eyes.

Acquired obstruction of the lacrimal drainage system, which is a blockage that develops later in life, is another common eye concern. This leads to symptoms like excessive tearing, discharge from the tear ducts, and swelling near the inner corner of the eye. About 3% of all eye doctor visits relate to this issue, with it being diagnosed in 37 out of every 100,000 people every year. This condition is most often seen in the tear duct or the openings in the eyelids where tears drain from, and it commonly affects women over the age of 40.

Signs and Symptoms of Dacryostenosis (Blocked Tear Duct)

Congenital Dacryostenosis, also known as a blocked tear duct, often presents itself with symptoms like constant or sporadic teary eyes and debris on the lashes. Furthermore, a baby’s tears may increase when exposed to specific factors such as wind, cold, or during instances of blocked nasal passages. Medical professionals will also require information about the baby’s health history, including pregnancy details, premature birth, family history of tear duct issues or congenital glaucoma, and other congenital anomalies.

Typical symptoms you may observe include:

  • Excessive tearing
  • Debris on the eyelashes
  • Reflexive tears or mucoid discharge from the eye
  • Light redness of the lower eyelid

If your baby has symptoms that differ from these, such as eye redness, purulent discharge, or enlarged corneas, it could point to other diagnoses including infection or glaucoma.

In older children and adults, acquired Dacryostenosis or acquired blocked tear duct can occur. The symptoms are similar to those seen in infants, though patients may also complain of other things such as frequent infections, painful swelling near the tear duct, or possibly a nose bleed in more serious situations where the problem could involve tumors in the nasal passages or eyes. Your doctor will need to know about any previous eye surgeries, history of glaucoma, trauma, illnesses, chemotherapy, or topical medications.

Potential symptoms in this case include:

  • Overflow of tears
  • Tenderness or a visible bump over the tear duct or near the eye corner
  • Eye discharge after massaging the tear duct

Over time, the duct may narrow and cause the lacrimal sac to dilate, leading to a protrusion in the corner of the eye. If an infection occurs in the tear sac, it can cause symptoms like redness, pain, throbbing, excessive tears, and discomfort near the eyelid corner, often accompanied by a severe headache. Chronic inflammation can occur if the blockage does not get resolved, leading to recurring acute episodes.

Testing for Dacryostenosis (Blocked Tear Duct)

Dacryostenosis is a condition generally diagnosed based on your medical history and physical examination. However, if your doctor is unsure, they might recommend a few tests to confirm the diagnosis. Here are some examples:

Fluorescein dye disappearance test (FDDT): This test involves your doctor putting anesthetic drops and fluorescent dye in your eyes. After about five minutes, the doctor will examine your eyes again. If there’s no blockage in your tear ducts, the dye would have drained into your nose. However, if there’s a blockage, you’d still have a lot of dye in your eyes or running down your cheek.

Dacryocystography: In this test, your doctor injects a contrast fluid into your tear system, so it’s visible on X-rays. This test helps the doctor see where the tear ducts are blocked and plan any necessary surgery. Magnetic resonance dacryocystography is an advanced version of this test that provides more detailed images.

Dacryoscintigraphy: This procedure, although giving less detailed images than dacryocystography, is less invasive and can better detect less severe blockages.

Imaging tools: Your doctor can use noninvasive methods like CT scans, MRIs, high-frequency ultrasound, and optical coherence tomography to examine your tear ducts. CT scans, for instance, are helpful in ruling out tumors. However, routine CT scans are not usually recommended due to the risk of radiation exposure. If a tumor is suspected, an MRI with a contrast substance called gadolinium may provide more precise information.

Lacrimal duct irrigation: This involves your doctor flushing your tear ducts with saline solution. If the saline comes back out the same eye, it’s a sign of dacryostenosis or a blocked tear duct.

Extra tests:

Tear production: Your doctor may perform tests to see if your tears are causing your symptoms.

Schirmer test: This measures how many tears your eyes make. Afterward, your doctor will measure how wet a special strip of paper is. After five minutes, a normal amount of wetting is between 10 and 30 mm without anesthetic, or more than 5 mm with anesthetic.

Tear break-up time: This test measures how long it takes for your tears to evaporate. If it takes 10 seconds or less, it means there’s a problem with your tears.

Your doctor can use a tool called a lacrimal probe to try to identify and measure the blockage if there’s an obstruction during the lacrimal duct irrigation.

Laboratory Studies:

In certain conditions, your doctor may order lab tests such as fungus stain, bacterial cultures, certain antibody tests to check for scleroderma, anti-cytoplasmic antibodies for granulomatosis with polyangiitis, or a biopsy of the tear sac.

Treatment Options for Dacryostenosis (Blocked Tear Duct)

In most cases, almost 90% of infants with blocked tear ducts can find relief within their first year through non-surgical treatments. Caregivers can help by gently massaging the area around the tear duct about two to three times a day. Doctors may prescribe antibacterial ointment to prevent infection. However, if the symptoms continue beyond six to ten months, the baby should be examined by an eye doctor. During this eye check-up, the doctor will also look for a condition called anisometropia, which affects approximately 10% of babies with congenital tear duct obstruction. Depending on the findings, the doctor may suggest a procedure called nasolacrimal duct probing.

If the blockage continues after the baby’s first year, physicians may recommend a procedure called lacrimal duct probing. In this procedure, the eye doctor inserts a small tool into the tear duct until it hits the blockage, then gently pushes through to clear it. Once the obstruction is cleared, the doctor rinses the tear duct with saline solution. This procedure can be done in a doctor’s office with local anesthesia or in a hospital under general anesthesia. If the child is one year or older, it’s typically done under general anesthesia.

The right time to do the probing procedure is a topic of debate among doctors. Some prefer to do it between six and ten months, while others wait until the baby is a year old. Early probing can reduce symptoms quicker and lower the risk of damage to the tear duct but waiting may allow the issue to resolve on its own.

Other treatments include nasolacrimal intubation which combines probing with the placement of a silicone stent, a type of tube, in the tear duct. This stent is usually left in place for two to six months. Another option is balloon dacryoplasty, a minimally invasive technique used for blockages that haven’t responded to other treatments. This process also typically involves leaving a stent in place.

A more complex procedure known as dacryocystorhinostomy (DCR), involves making a new connection between the lacrimal sac and the nasal cavity by removing a part of the lacrimal bone. A laser-assisted version of DCR is also available. It requires less tissue removal but is also less successful than the standard DCR procedure.

Lastly, a procedure named conjunctivodacryocystorhinostomy is used for patients with significant anatomic abnormalities or other serious conditions. In this treatment, a glass tube is placed between the teardrop collecting area and the nasal cavity to support drainage. This procedure relies on gravity for drainage, and patients may need to remove and clean the tube periodically. This draining device has been tolerated by patients for at least four decades.

The possible causes of dacryostenosis, a condition where the tear duct is blocked, also include the following:

  • Pink eye (conjunctivitis)
  • Eyelid inflammation (blepharitis)
  • Foreign objects in the eye
  • Scratched cornea (corneal abrasion)
  • Corneal ulcer, an open sore on the clear front surface of the eye
  • Inflammation of the cornea (keratitis)
  • Childhood glaucoma
  • Infection of the tear sac (dacryocystitis)
  • Birth defects that affect the structure of the eye
  • Cysts in the tear duct
  • Allergic pink eye
  • Abnormal eyelash growth direction (trichiasis)
  • Birthmarks near the tear duct area
  • Damage issues from injuries around the eye and orbit
  • Tumors that may press on the tear sac
  • Blocked nasal passage or bent nasal septum
  • Inflammation inside the eye (uveitis)
  • A swollen lacrimal sac filled with amniotic fluid (dacryocystocele)

It’s important to see an eye specialist who will think about these potential causes, and carry out appropriate tests to confirm the exact cause of the problem.

What to expect with Dacryostenosis (Blocked Tear Duct)

In children, spontaneous recovery often happens without intervention within 6 to 12 months for about 90% of patients. However, if the obstruction continues for more than a year, the chances of a spontaneous recovery are low. Spontaneous recovery in adults with a similar condition is rare. The chances of improvement depend on the surgical technique and other health factors, if surgery is needed.

For children, a procedure known as nasolacrimal duct intubation has a high success rate of between 90% and 96% when used as the initial treatment and 84% when carried out after other procedures have proven unsuccessful.

In adults, the procedure generally relieves symptoms completely in 77% of the patients, with success rates of 96% after 2 years, and 85% after 3 years. Balloon dacryoplasty, another treatment, has a success rate of 82% when used as the primary treatment and 77% when used following unsuccessful probing.

Both external and internal DCR (a type of surgical procedure) have comparable success rates and, generally, have been successful in around 95% or more of cases in most studies. Using an endoscopic approach (where a small camera is used to view and treat the affected area) is often preferred as it allows the surgeon to spot and fix issues within the nasal passages, which are common causes of DCR failure.

Possible Complications When Diagnosed with Dacryostenosis (Blocked Tear Duct)

If dacryostenosis, which is a tear duct blockage, is not treated, it can get worse and lead to chronic inflammation of the eye and tear sac (conjunctivitis and dacryocystitis). It can also result in other complications like severe eye infection (endophthalmitis), brain inflammation (meningitis), brain abscesses, and infection of the tissues around the eye (orbital cellulitis).

These serious conditions manifest with specific signs and symptoms. For example, an acute inflammation of the tear sac, known as acute dacryocystitis, can cause redness, swelling, warmth, tenderness around the lacrimal sac (tear duct), and pus discharge.

About 10% of children with blocked tear ducts (NLDO) may develop uneven refractive fault in the eyes (anisometropia), with or without lazy eye condition (amblyopia). In rare instances, chronic inflammation can lead to the creation of abnormal connections or passageways in the body (fistulas) near the tear ducts (lacrimal fistulas).

Other complications can also occur, such as:

  • Scarring of the passageway that drains tears from the eyes into the nose (nasolacrimal duct) following surgical intervention,
  • Unfavorable responses to anesthesia,
  • Infections that appear as a result of the surgical procedure.

Preventing Dacryostenosis (Blocked Tear Duct)

Congenital dacryostenosis is a condition where a tear duct doesn’t form properly during development, leading to blocked tear ducts. This condition can also develop later in life due to tumors, injuries, radiation, chemotherapy, blockages, or inflammation. The main symptom in people with dacryostenosis is teary or watery eyes.

Doctors and nurses teach patients and their caregivers about the normal tear drainage process because it helps to understand what part of the process is being blocked. While doctors can often diagnose this condition in newborns and infants just by looking at their symptoms, adults might need more tests. These can include a variety of scans and endoscopy to fully understand the problem.

It’s important for patients and caregivers to know that if the person with the blocked tear duct experiences skin redness, oozing pus, pain, or headache, they should get in touch with their healthcare team right away. These symptoms could mean an infection, which needs quick treatment to prevent serious problems like skin infections, meningitis, and brain abscesses.

Surgery can often fix this problem, and it usually works quite well. For most babies with this condition, the symptoms will improve by the time they reach 12 months old if their caregivers regularly massage the tear duct area. If things don’t get better, doctors might consider surgery for babies starting at 6 to 7 months old. For adults who develop blocked tear ducts, the problem is less likely to go away on its own, so they may need procedures like probing, intubation, dilation, or even a special type of surgery in severe cases.

Frequently asked questions

Dacryostenosis is a medical condition characterized by a blockage in the tear duct, also known as nasolacrimal duct obstruction (NLDO). This condition causes excessive watering of the eyes and can occur from birth or develop later in life.

Dacryostenosis (Blocked Tear Duct) is fairly common, affecting around 6% of all newborns.

Signs and symptoms of Dacryostenosis (Blocked Tear Duct) can vary depending on whether it is congenital or acquired, and whether it occurs in infants or older children/adults. Here are the signs and symptoms for each: Congenital Dacryostenosis (Blocked Tear Duct) in infants: - Excessive tearing - Debris on the eyelashes - Reflexive tears or mucoid discharge from the eye - Light redness of the lower eyelid Acquired Dacryostenosis (Blocked Tear Duct) in older children and adults: - Overflow of tears - Tenderness or a visible bump over the tear duct or near the eye corner - Eye discharge after massaging the tear duct It is important to note that if a baby has symptoms that differ from the typical signs of congenital Dacryostenosis, such as eye redness, purulent discharge, or enlarged corneas, it could indicate other diagnoses including infection or glaucoma. In older children and adults, symptoms may also include frequent infections, painful swelling near the tear duct, or even nose bleeds in more serious cases involving tumors in the nasal passages or eyes. Additionally, if an infection occurs in the tear sac, it can cause symptoms like redness, pain, throbbing, excessive tears, and discomfort near the eyelid corner, often accompanied by a severe headache. Chronic inflammation can also occur if the blockage is not resolved, leading to recurring acute episodes.

Dacryostenosis (Blocked Tear Duct) can be acquired due to various factors such as infections, inflammation, tumors, trauma, mechanical disorders, and aging. It can also be congenital, meaning a person is born with it.

The doctor needs to rule out the following conditions when diagnosing Dacryostenosis (Blocked Tear Duct): - Pink eye (conjunctivitis) - Eyelid inflammation (blepharitis) - Foreign objects in the eye - Scratched cornea (corneal abrasion) - Corneal ulcer, an open sore on the clear front surface of the eye - Inflammation of the cornea (keratitis) - Childhood glaucoma - Infection of the tear sac (dacryocystitis) - Birth defects that affect the structure of the eye - Cysts in the tear duct - Allergic pink eye - Abnormal eyelash growth direction (trichiasis) - Birthmarks near the tear duct area - Damage issues from injuries around the eye and orbit - Tumors that may press on the tear sac - Blocked nasal passage or bent nasal septum - Inflammation inside the eye (uveitis) - A swollen lacrimal sac filled with amniotic fluid (dacryocystocele)

The types of tests that may be ordered to diagnose Dacryostenosis (Blocked Tear Duct) include: 1. Fluorescein dye disappearance test (FDDT) 2. Dacryocystography or Magnetic resonance dacryocystography 3. Dacryoscintigraphy 4. Imaging tools such as CT scans, MRIs, high-frequency ultrasound, and optical coherence tomography 5. Lacrimal duct irrigation 6. Tear production tests like the Schirmer test and tear break-up time test 7. Use of a lacrimal probe during lacrimal duct irrigation to identify and measure the blockage 8. Laboratory studies such as fungus stain, bacterial cultures, certain antibody tests, or a biopsy of the tear sac.

Dacryostenosis, or blocked tear duct, can be treated through various methods depending on the severity and duration of the condition. Non-surgical treatments are usually recommended for infants under one year old, such as gentle massaging of the tear duct area and the use of antibacterial ointment. If the symptoms persist beyond six to ten months, an eye doctor may suggest a procedure called nasolacrimal duct probing. For older children and adults, lacrimal duct probing, nasolacrimal intubation, balloon dacryoplasty, and dacryocystorhinostomy are among the treatment options. In more complex cases, conjunctivodacryocystorhinostomy may be used, which involves placing a glass tube to support drainage.

The side effects when treating Dacryostenosis (Blocked Tear Duct) can include: - Scarring of the passageway that drains tears from the eyes into the nose (nasolacrimal duct) following surgical intervention. - Unfavorable responses to anesthesia. - Infections that appear as a result of the surgical procedure.

The prognosis for dacryostenosis (blocked tear duct) depends on the age of the patient and the treatment received. Here are the key points: - In children, spontaneous recovery often happens without intervention within 6 to 12 months for about 90% of patients. However, if the obstruction continues for more than a year, the chances of spontaneous recovery are low. - For children, a procedure known as nasolacrimal duct intubation has a high success rate of between 90% and 96% when used as the initial treatment and 84% when carried out after other procedures have proven unsuccessful. - In adults, the procedure generally relieves symptoms completely in 77% of the patients, with success rates of 96% after 2 years, and 85% after 3 years. Balloon dacryoplasty, another treatment, has a success rate of 82% when used as the primary treatment and 77% when used following unsuccessful probing. Both external and internal DCR (a type of surgical procedure) have comparable success rates and have been successful in around 95% or more of cases in most studies.

An ophthalmologist or an eye doctor.

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