Dr. Affleck treats Painful Blocked tear ducts

The tear ducts are small holes in the nasal corner of each eyelid, upper and lower, that drain tears and mucus from the eyes into the nasal sinus.  In children, obstruction of these ducts is common, and often resolves without treatment. In adults, an obstruction in the ducts can be caused by trauma, like a broken nose, surgery in the nasal sinus, chronic sinus inflammation, or sometimes without any cause. The bottom end of the tear duct is a small bony canal, and often after an obstruction develops, the bone closes off the canal.

Children

Inside the tear ducts are two valves that prevent flow of tears and mucus back up into the eye. The lower valve is often not open at birth, causing infants to have watery eyes with some mucus.  A majority of these will spontaneously resolve in the first few months of life.  If the obstruction has not resolved by 3-4 months, conservative treatment can be started.  This includes antibiotic eye drops and gentle massage of the ducts to encourage flow.  If infants younger than 3 months old have significant discharge, breast milk can be expressed into the eyes as it has antibiotic properties to minimize an infant’s exposure to antibiotics.  If there has been no resolution of the obstruction in the duct(s), a procedure called a probing can be performed to open the duct(s).

In children less than 12 months old, a probing can be done safely in the office.  The child is wrapped in a papoose board (similar to being wrapped in a receiving blanket). An eyedrop to numb the eye is instilled, and a probe is gently pushed through the duct, overcoming any obstructions. The probing happens quickly, about as fast as an immunization shot.  If a child is over 12 months, this procedure is performed under anesthesia in a surgical facility.

If a probing is unsuccessful at restoring flow through the duct(s), a tube can be placed in the tear duct to hold the system open.  This is done under anesthesia.  The tube is left in place for 6-8 weeks, and then removed easily in the office.

Adults

In adults, the tight bony canal often fills in with new bone, so the approach to restore flow is different than children.  Since the symptoms of a tear duct obstruction and other conditions, such as dry eyes and allergies, overlap there are simple techniques in the office that can be used to assure the correct diagnosis. Often, this involves gently flushing a small amount of water into the duct to see if any makes it into the nose.

In most cases of obstruction in adults, the definitive treatment is surgery. The surgery involves making a small opening in the bone in the sinus to effectively make a bypass tract for tears to drain. This is called a dacryocystorhinostomy or DCR.

The external approach for a DCR is to make an incision along the lower eyelid by the nose, and make the opening manually.

There is an endoscopic technique where the opening is made from the inside of the sinus.  The benefit of this technique is that there is no visible scar.

Years ago, Dr Affleck started using an endoscopic approach that employs a laser to make the opening in the bone.  This technique involves an ear, nose and throat surgeon to perform nasal endoscopy.  The best location for the opening is identified, and the laser is used to make the opening. This requires much less manipulation of the tissue, has less pain post operatively, and in many studies, has a higher success rate with less scarring.

All adult tear duct surgeries are done under general anesthesia. During these surgeries, a tube is placed into the ducts, and through the new opening in the bone. The tube prevents the new opening from scarring closed. The tube is left in place for 6-8 weeks, or longer, and then removed in the office later.