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What is tear duct obstruction?

One of the symptoms affecting the eye and worrying people is excessive watering of the eyes. Although in many situations involving exposure to the cold or wind it's normal and very common for the eyes to water, there are people who are constantly facing this issue. 

It's called epiphora or constant eye watering due to a drainage issue, which makes daily activities difficult and becomes a pathology that needs to be seen to by an ophthalmologist.

The tear duct is a tube-shaped drainage system that collects tears using small orifices (names lacrimal punctum) in the side closest to the nose of both eyelids and sends it to the nose. 

The tears that have not evaporated, empty out the nose through a system consisting of tubes, canaliculi (in the eyelids), the lacrimal sac and the nasolacrimal duct. 

When should I go to the ophthalmologist?

Obstruction of this tube system causes an accumulation of tears that the nose cannot drain. The eye has excess water and it fails to eliminate all types of debris.  
 

If the tear duct is blocked at any point in its trajectory, the tear overflows and the patient cries.

Obstruction of the tear duct could be for different reasons (age, nose trauma, nasal allergies, conjunctivitis, a tumour).  

In children, obstruction of this conduct could be due to the fact that it did not develop correctly at birth. It's important to see the ophthalmologist as soon as possible to determine the best course of treatment.

Symptoms

  • Eye watering, blurred vision, eye irritation or conjunctivis 
  • Mucous secretion, lacrimal sac inflammation (internal angle of the eyelid) 
  • Skin maceration

What treatments currently exist?

High obstructions (proximal) that are located in the lacrimal punctum may be treated with cortisone eyedrops, in the event that the obstruction is due to oedema (swelling) or with punctoplasty, a surgical techique used to widen the drain opening. 

When lacrimal system obstructions are located deeper, also known as low obstructions (distal), they always requie surgery known as a dacryocystorhinostomy (DCR). There are various approach alternatives to make a new drainage opening to the nasal cavity in order to get round the obstruction the obstruction created. 

Dacryocystorhinostomy (DCR) 
It involves making a new bone window in the lacrimal bone which joins the lacrimal sac to the bone, in order to get round the obstruction created. 

Classic or external DCR
A small incision is made in the skin which use to make an orifice that connects the tear duct to the nose again. 

Because it is done through the skin, this technique can make the hole or osteotomy larger in size than other techniques can. Making a larger hole provides the lacrimal system with better permeability after the healing of the wound. 

Diode laser-assisted DCR
It is made with laparoscopic tecniques, using a camera and a television screen. 

A connection with the lacrimal system and nose is created with the help of a small diode laser probe which is inserted into the lacrimal punctum in such a way that the resulting osteotomy is smaller than the external technique but we avoid making a wound on the eyelid skin.

Professionals who treat this pathology

Frequently asked questions

  • It is most likely that your tear duct is swollen. The tear duct is a conduct through which the tears pass until they get to the nose. If it is blocked (which happens relatively frequently), the tears do not have any way of draining, and that is why your eyes water. It stops the eye from cleaning itself properly, which promotes recurring conjunctivitis (red eye, secretion...). On the other hand, the lump is the lacrimal sac, which sometimes gets infected (dacryocystitis if it does not drain properly. When faced with the symptoms mentioned and once the diagnosis has been confimed at a doctor's appointment, we would advise having surgery to put an end to the irritation and avoid new infections. 

  • Tears normally drain from the eye to the nasal cavity without dripping down the fact. This process occurs through thelacrimal duct, a drain that starts at a small point of the lower eyelid and opens towards the nasal cavity via the lacrimal sac. So that tear drainage towards the nose is correct, the duct needs to have the right calibre, so that the tear stream passing through it without any major issues and, in addition, the lacrimal punctum needs to be in the right position. Under normal conditions, the lacrimal punctum is in closely bound to the eyeball. This makes the tears flow through the eyelid edge until they fall through the punctum and start to drop down towards the nose. If this punctum loses contact with the eyeball, the tears cannot find a normal way out and "fall" down the face, which the person perceives as watering. This is what is happening with your husband: the punctum as separated from the eye, which is what we call lacrimal punctum ectropion. Although it's a very annoying problem, on its own it is not a serious condition and, in addition, the ophthalmologist can fix it with a simple outpatients procedure, in which the lacrimal punctum is placed in its original position, which will make the annoying eye watering disappear.