Brief overview
- Treatment: The physician first treats conservatively (without surgery) e.g. by means of tear sac massage, antibiotic eye drops, eye rinsing. If there is no improvement, surgery is usually necessary.
- Causes: A blocked tear duct is either acquired (e.g., due to infection or injury) or congenital (e.g., due to malformation).
- Description: Blocked or narrowed tear duct through which the tear fluid no longer flows freely.
- Diagnosis: conversation with the doctor, examination of the eye, ultrasound if necessary, X-ray.
- Course: Usually well treatable. In severe cases, abscesses of the lacrimal sac and inflammation of the surrounding tissue occur.
What can be done against a blocked tear duct?
Non-surgical treatment
Initially, the doctor tries to treat a blocked tear duct without surgical intervention (conservatively). In doing so, he or she proceeds as carefully as possible to avoid further injury to the eye. Especially in infants, it is important that the treatment is as gentle as possible. This is because even the smallest injuries can lead to scarring in the area of the nasolacrimal duct.
With babies, wait and see first
If the membrane does not form back, the nasolacrimal duct remains closed or severely narrowed. As a result, the tears cannot drain through the nose, back up and finally run over the edge of the eyelid.
Tear sac massage
In some cases, a tear sac massage also helps to open the tear duct. For this purpose, the area of the lacrimal sac is massaged with stroking movements from the inner corner of the eyelid to the nose with the fingertips. By applying gentle pressure to the lacrimal sac, you try to “burst” the membranous occlusion with the help of the stagnant fluid.
Have an ophthalmologist or pediatrician show you the massage technique beforehand!
Home remedy
Home remedies alone are not recommended to treat a blocked tear duct. Have the symptoms clarified by a doctor beforehand!
The warmth of the compress promotes blood circulation and, if necessary, helps to widen the tear duct somewhat. Warm or cold infusions of calendula, black tea or oak bark are also suitable for eye compresses. Ask your doctor or pharmacist about this.
An eye wash (eye douche) from the pharmacy can also provide relief in the case of an irritated eye (e.g. due to foreign bodies such as small stones). It usually contains sterile saline solution that corresponds to the natural salt content of the eyes.
Do not use tap water for eye rinsing. This further increases the risk of infection.
In some cases, rinsing the nose with a saline solution also helps. The lacrimal duct ends in the nose, so it is possible that the cause of the blockage is also there. This can be cleared by means of a nasal irrigation if necessary.
Use home remedies only after consulting your ophthalmologist and wash your hands thoroughly before each use!
In the case of acute infections and signs of bacterial inflammation (e.g. pus in the corners of the eyes), the doctor often prescribes antibiotic eye drops. They inhibit the formation of bacteria and thus the inflammation. The affected person (or in the case of babies, the parents) instills the eye drops into the eyes several times a day for several days. Your ophthalmologist will tell you which dosage is necessary in your individual case.
Irrigation of the tear ducts
If the tear duct does not open by itself or by massaging the lacrimal sac, the doctor flushes the draining tear ducts with saline solution. For this purpose, he uses a special cannula (thin hollow needle), which he carefully inserts into the blocked tear duct.
Surgery
In severe cases (e.g. injuries) or when non-drug treatment does not bring the desired success, the doctor performs surgery on the eye.
Probing of the tear ducts
Occasionally, it is necessary for him to insert an inflatable small balloon into the tear duct to widen it even more (balloon dilatation). In some cases, the doctor inserts a thin plastic tube or thread for three or four months to allow the tears to drain again.
Dacryocystorhinostomy (DCR)
The doctor leaves it there for about three to six months to prevent the lacrimal duct from growing shut again. The procedure is also performed under general anesthesia.
Endonasal lacrimal duct surgery
In adults, surgery is often the only way to successfully and permanently remove long-standing blockages in the tear duct. In babies, it is only necessary in exceptional cases.
How does a blocked tear duct develop?
A blocked tear duct has several possible causes. These include:
Incompletely developed nasolacrimal duct.
In five to seven percent of all newborns, the membrane of the tear duct does not open on its own after birth, and the nasolacrimal duct remains closed or severely narrowed. As a result, the tears cannot drain through the nose, back up and eventually run over the edge of the eyelid (congenital or connatal lacrimal duct stenosis).
Malformed facial or cranial bones may also lead to blocked tear ducts.
Inflammation of the lacrimal ducts
Injuries to the tear ducts
If the tear ducts or surrounding bone areas are injured (e.g., by a blow to the face or an accident), the tear duct may be obstructed as well.
Narrowed tear ducts in old age
In the course of the aging process, the tear ducts narrow in some people. This increases the risk of the tear ducts becoming blocked.
Tumors, cysts, stones
What is meant by a blocked tear duct?
The lacrimal gland regularly secretes tear fluid to evenly moisten the eye by blinking. In the inner corner of the eye, the excess tear fluid drains into the nose via the tear ducts – consisting of tear spots, tear tubules as well as the nasolacrimal duct.
As a result, tear fluid can no longer drain properly, causing the tear fluid to run over the edge of the eyelid (epiphora) – the eye tears.
While lacrimal duct stenosis in adults is usually caused by inflammation or injury to the lacrimal ducts, in children it is predominantly the result of an incompletely developed nasolacrimal duct. Five to seven percent of all newborns are affected by such a congenital lacrimal duct stenosis.
A blocked tear duct causes various symptoms in both babies and adults. Affected individuals show symptoms including the following:
- The eye is constantly watering (e.g., even when the child is not crying).
- Tears run down the edge of the eyelid or down the cheek.
- The affected person’s vision is blurred.
- The eyes itch and are very red (symptoms are similar to those seen in dry eye).
- The facial skin is irritated and reddened by the tears.
- If the tear duct remains blocked for a long time, the lacrimal sac often becomes inflamed (dacryocystitis). Mucus flows out from the tear points when pressure is applied to the lacrimal sac area (mucus plug).
- The tears appear more viscous (lacrimal fluid in the lacrimal sac thickens).
- The affected person has swelling and pain in the area of the inner corner of the eye.
In babies, the first symptoms usually become noticeable in the first few weeks after birth.
What does the doctor do?
If the symptoms persist (e.g. watery eye, pain in the eyes), it is necessary to consult a doctor. The first point of contact is your family doctor. If necessary, he or she will refer you to an ophthalmologist or ENT specialist for further examinations.
Anamnesis
The physician first conducts a detailed interview with the patient (anamnesis). Among other things, he asks questions about the existing symptoms, for example:
- When did the symptoms occur?
- Did they arise suddenly or did they develop over a longer period of time?
- Are possible triggers for the complaints (e.g. an injury) known?
Examination of the eye
To test whether the tear duct is blocked, he then drips a colored fluid into the eye. If the doctor observes that the colored tear fluid does not drain off at the inner corner of the eye as usual, or if the person affected even tastes the fluid and feels it running down the back of the throat, this provides him with initial indications of a blocked tear duct.
If inflammation is present, pus also frequently flows out of the lacrimal sac when pressure is applied to the corner of the eye.
Ultrasound and X-ray examinations are suitable for further clarification. In an X-ray, the physician visualizes the drainage conditions in the nasolacrimal duct, among other things. To do this, he rinses the lacrimal duct with contrast medium beforehand.
