TEAR DUCT OBSTRUCTION
What is it?
An obstruction of the tear duct and subsequent infection. The obstruction can occur at any point of the tear duct.
The tear is produced in the lacrimal gland and is excreted (eliminated) through the tear duct. In some patients, for different reasons, the tear duct becomes obstructed, which prevents or hinders the normal drainage of the tear. In these cases, the tear is retained in the eye, which causes constant tearing and, in some cases, infection of that tear (similar to stagnant water) causing conjunctivitis and dacryocystitis.
The tear duct may be blocked at birth (congenital tear duct obstruction). In fact, approximately 20% of newborns have a tear duct obstruction, which generally resolves spontaneously during the first year of life.
Causes
Lacrimal duct obstruction has been associated with various causes, from a congenital obstruction (present at birth) to an inflammation of the sinuses (sinusitis). The various causes of lacrimal duct obstruction include craniofacial abnormalities, age-related changes, nasal trauma, nasal polyps, severe conjunctivitis, or even the presence of tumors that can occlude the lacrimal duct.
Symptoms
The main symptom is excessive and practically constant tearing, which may be associated with discharge. Sometimes a red eye may appear and even the appearance of a small lump in the inner corner of the eye at the level of the lacrimal sac, called a mucocele. In more severe cases, an infection of the lacrimal sac (dacryocystitis) can occur, causing inflammation and severe pain in the inner corner of the eye.
In exceptional cases, it can present with inflammation of the periocular soft tissues (preseptal cellulitis) or of the orbit (orbital cellulitis).
Diagnosis
The diagnosis is basically clinical. An ophthalmological examination with special attention to the anterior segment may suggest the picture. In a patient with symptoms compatible with an obstruction of the lacrimal duct, an examination of the lacrimal duct should be performed. It is a technique that is performed under topical anesthesia, which consists of introducing a blunt cannula (without a tip) through the lacrimal point and irrigating with a syringe connected to the cannula a serum to check if it passes into the throat (if it does not pass, it is a sign indicative of lacrimal duct obstruction).
If cellulite is suspected, a CT scan is indicated.
Treatment
Those patients with an active infection should be treated with antibiotics (topical and / or systemic, as appropriate) and anti-inflammatory (topical and / or systemic, as appropriate). Sometimes, in the most severe cases, the lacrimal sac may need to be drained.
In newborns or young children, whose duct does not open spontaneously, as well as in adults with partial blockage of the lacrimal points, there is a technique that uses dilatation of the lacrimal point, catheterization, and irrigation.
In patients with severe epiphora (tearing) and / or recurrent infections, the indicated treatment is surgery: Dacryocystorhinostomy. This technique consists in the realization of an alternative communication between the lacrimal sac and the nostril through an opening that is made at the level of the lacrimal bone and is called an osteotomy. A silicone intubation may be necessary for a few weeks to try to close the created hole. It is normally performed under local anesthesia and with sedation or general anesthesia and, generally, the patient is discharged the same day of the intervention.
Prognosis
Dacryocystorhinostomy is a very safe technique, however, after surgery some inflammation may appear that resolves spontaneously. The most common complication is a new closure of the tear duct, which would require a new intervention (it must be evaluated by your ophthalmologist).
In most cases, dacryocystorhinostomy resolves the obstruction of the lacrimal duct, which means eliminating lacrimation and the risk of infection.
