Obstruction Of The Tear Ducts

There are thin canals in the eye draining away the excessive tears to the nose. Lachrymal duct obstruction is mostly observed in babies and women after menopause. Since tears cannot pass to the nose, they flow through the cheek from the eyelid. Lachrymal duct obstruction causes infection in the eye and canal area. Patients mostly complain about blurring in the eye,  inflammation when the nasal root is pushed, and protuberance in the side of the nasal root.

Figure 1. Nasolacrimal system anatomy and stenosis of the distal nasolacrimal duct.

Lachrymal Duct Obstruction in Babies (Congenital Dacryocystitis): It is mostly recognized within the first 2 months after birth in one or both eyes in the form of watering or burring. Massage application is carried out for the first year. The massage is performed as downward strokes from the nasal root. These massage movements should be repeated 10-15 times for 3-4 days. The possibility of the canal opening by itself with massage is 95%. If intense burring or redness occurs in the eye, antibiotic eye drops are used. Burrs should be cleaned to prevent burrs from drying in the eye. If complaints continue to appear at the end of one year, it means that the canal has not opened. Then “drilling” operation is carried out. Since the patient is a baby, drilling is carried out under anesthesia. If the complaint of watering is not eliminated after the first drilling, a second drilling is made 2 months later. A silicone tube may be placed in the patient during the second drilling. If watering is still not eliminated, the surgery called dacryocystorhinostomy is carried out.

Figure 2. Demontrartion of external dacryocystorhinostomy surgery (left) and external appearance of bicanalicular silicone tube (right). 

Lachrymal Duct Obstruction in Adults: If there is active infection, antibiotic treatment should be used. When the infection has healed, the disorder is treated by dacryocystorhinostomy surgery. A 1-cm cut is made on the skin in the nasal root under anesthesia. A piece in 1x1cm in size is extracted from the nasal bone. A direct pass is created from the lachrymal sac to the nasal cavity. In some cases, a silicone tube can be passed temporarily through the holes in the eyelid called punctum. The cut on the skin is stitched and the operation is completed. Antibiotic treatment is administered after the surgery in order to prevent wound infection. A scar may occur on the cut skin depending on the healing characteristics of the patient. After a while, the obstruction may develop again at a rate of 10-15%.