Introduction
Are you currently struggling with a heavy dripping or overflowing eye? This dripping of tears could be an indication of lacrimal duct stenosis. This is a closure of the lacrimal duct.
The lacrimal gland is located above the eye, approximately at the level of the outer eyelid, and produces the tear fluid. This fluid is used to moisten and nourish the cornea and to wash out and protect it from foreign bodies. The eye is evenly moistened by the blinking of the eyelid.
This tear fluid must also be drained off, which is done via the tear ducts at the inner corner of the eye. There, there are so-called tear dots, through which the liquid passes through the tear ducts, the lacrimal sac and the nasal passage into the nose. However, if the tear duct is blocked and thus hinders the outflow, a continuous watery eye occurs.
This blockage can also cause severe inflammation. The main symptoms of lacrimal duct stenosis are a continuously running eye and painful swelling in the area of the inner corner of the eye. Furthermore, it can cause irritation of the eye and, in the advanced stages, inflammation of the lacrimal sac.
In this case, the typical signs of inflammation such as redness, overheating, pain, swelling and impaired function become noticeable and purulent secretions are possible. In adults, the increased amount of tear fluid in the eye results in blurred vision. If there is a suspicion of a stenosis of the tear ducts, an ophthalmologist should be consulted immediately.
He or she will determine whether a blockage or narrowing of the lacrimal duct actually exists and where exactly the blockage or narrowing can be located. Suitable diagnostic procedures may include an ultrasound and X-ray examination of the lacrimal sac. In most cases, an eye test, a close external examination of the eye and a thorough lacrimal duct irrigation complete the diagnosis and examinations prior to a possible lacrimal duct surgery.
The treatment of lacrimal duct stenosis differs depending on the cause of the disease. In most cases, however, probing and irrigation of the lacrimal duct is recommended because it is a minor procedure with a high cure rate. If the occlusion is caused by an infection, it is first treated with antibiotics and then, after the acute inflammation has been eliminated, tear duct surgery is performed.
The method of surgery depends on the location of the occlusion. In addition to probing with a fine metal probe, there is also the possibility of dilating the lacrimal ducts with a balloon dilatation. If the nasolacrimal duct is completely blocked, a dacryocystorhinostomy can be performed, in which an artificial duct is created between the lacrimal sac and the nose through the bone to ensure the drainage of tear fluid.
There are also different methods of this operation, one can operate from the inside through the nose itself, the other through an incision in the skin from the outside. In both cases, a fine, soft silicone tube is inserted so that the newly created path remains open and functional during the postoperative healing phase. Infants are first observed to see if the tear duct opens spontaneously during the first year of life.
If this is not the case, the occlusion should be treated by probing the lacrimal duct. During this short tear duct surgery, which is performed under general anesthesia, a fine metal probe is inserted to remove the stenosis. In severe cases, a silicone intubation is performed in addition to the probing.
Especially for babies, the tear sac massage has proven to be very effective. Here, slight pressure is exerted on the lacrimal sac to facilitate opening of the nasolacrimal duct and removal of the Hasner membrane. The fingertip of the little finger or index finger is moved from the inner corner of the eyelid to the nose under gentle, but not too light pressure.
The massage should be performed four times a day and should include ten repetitions of each massage technique. In order to guarantee correct performance, the parents concerned should have the technique demonstrated by an ophthalmologist or pediatrician. A solution of Euphrasia (eyebright) can be tried as a homeopathic remedy for cleaning the eyes.
To do this, dissolve about 15 globules of Euphrasia D6 in half a liter of lukewarm water.Ideally, you should use handkerchiefs or gauze bandages for application. With babies you can also use their cotton clothing for this. In addition, breast milk is said to have an anti-inflammatory and healing effect, so that you can try a wet washcloth sprinkled with breast milk.
We do not recommend chamomile tea for cleansing, absorbent cotton or cotton buds, however, as they can cause further irritation of the eye. In addition to injuries, obstructions or inflammation of the lacrimal ducts, there is also a congenital narrowing which can be the cause of lacrimal duct stenosis. In the womb, the lacrimal ducts are initially closed by tissue in the area of the nasolacrimal duct, the so-called Hasner membrane.
If this membrane does not completely recede shortly before birth, the drainage of tear fluid may be impaired. In most cases a spontaneous regression of this membrane takes place, but if this is not the case, it can also lead to an inflammation of the lacrimal sac. In addition, eyelid inflammation can cause swelling and occlusion of the upper lacrimal ducts.
All in all, lacrimal duct stenosis has a good prognosis. Especially in infants, the occlusion usually regresses on its own. In adults, too, the surgical options are very promising, although new occlusions can always occur. However, the surgical intervention from the outside has a higher success rate than the endoscopic treatment from the inside. The operation via the nose, however, is the gentlest method because it causes less tissue injury.
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