What is a nasolacrimal duct obstruction?
The eyes usually have just enough tear fluid to keep them wet. Some young children seem to have a constant overflow of tears, however.
Tears normally leave the eye through tiny openings on the edges of the eyelids. After passing through these openings, the fluid drains into the nose through little “tubes” called nasolacrimal ducts.
It is not unusual for a baby to be born before these ducts are completely open. This usually has no effect except for watery eyes. Most children just grow out of it.
The condition can become more serious, however, when tear fluid builds up inside the nasolacrimal duct. Eventually, the duct can become irritated and infected. This can lead to a permanent blockage called nasolacrimal duct obstruction.
Where exactly is the nasolacrimal duct?
The nasolacrimal ducts start underneath the skin at the corners of the eyes closest to the nose. They then go down through the bones of the face and actually open inside the nose. Normally, there is so little tear fluid that the nose does not get very wet. The connection between the eye and the nose is obvious, however, when someone is crying.
How does the doctor know when a child has nasolacrimal duct obstruction?
If a young child seems to have constantly overflowing tears, there might be a nasolacrimal duct obstruction. The doctor will look for the following symptoms:
- Overflowing tears without redness or irritation of the eye. (If the eye is red or irritated, the problem is more likely to be an infection, allergy, injury, or some other condition that must be treated first.)
- Cloudy or yellowish fluid in the tears.
How is nasolacrimal duct obstruction treated?
A careful examination is necessary to help the doctor decide whether a child has a nasolacrimal duct obstruction and recommend the right treatment.
If the child does have an obstruction, the doctor could recommend a very simple treatment. Placing a warm, wet, clean washcloth on the child's eye a few times a day can help the fluid inside the duct drain out. It is also sometimes helpful to massage gently between the child's eye and nose with a clean finger. This can help to drain fluid and also open the closed part of the nasolacrimal duct. Your doctor will explain exactly how to do this and how many times a day it should be done.
What if the obstruction does not go away?
It can take up to 1 year for the nasolacrimal duct to open on its own. If the obstruction is causing other problems, the doctor might recommend a procedure to open the duct. This is called nasolacrimal duct probing, and it might be necessary if the duct is infected. The doctor will probably prescribe antibiotics before the probing if there is an infection.
The doctor could do the probing procedure in the office, in which case only a local anesthetic is used to numb the eye. Usually the doctor recommends doing it in an operating room with general anesthetic (the child is “asleep” during the procedure).
No matter where it is performed, nasolacrimal duct probing has the same basic steps. First, a thin metal probe that looks like a wire is passed through the opening in the eyelid. This wire probe then passes through the nasolacrimal duct down to where it opens inside the nose. The doctor will squirt clean water through the nasolacrimal duct to make sure it can get through. After the doctor sees that the probe has cleared a path for the tears, the probe is removed.
Nasolacrimal duct probing is very successful in opening obstructions and stopping the overflow of tears.
Is there anything that can be done if probing does not fix the obstruction?
Sometimes the obstruction cannot be cleared by probing. An infection can also have the side effect of blocking the nasolacrimal duct completely. This is a problem for two reasons. Not only will the eye keep overflowing with tears, the blocked nasolacrimal duct will keep getting infected. Fortunately, there are other ways to fix the problem.
Your doctor can perform a procedure that is something like nasolacrimal duct probing, but instead of using a wire probe that is taken out at the end of the procedure, he or she places a small plastic tube that stays inside the duct for several weeks or months. This tube forces the nasolacrimal duct to stay open, and the duct usually remains open even after the device is removed.
Occasionally, however, the nasolacrimal duct simply will not work. Dacryocystorhinostomy is the complicated medical name for an operation to make a new tear drainage system.
This operation is almost always done under general anesthesia. The surgeon will make an incision near the nose and connect a small plastic tube to the tear duct near the eye.
In this procedure, the tube is not passed through the nasolacrimal duct. Instead, the surgeon makes a new opening through the bone so the other end of the plastic tube can reach the nose through a new opening.
The plastic device keeps the new drainage system open as the area heals. After a few months, the tube is removed. This procedure is very effective at solving the problem of the nasolacrimal duct obstruction.
This operation is almost always done under general anesthesia.
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