In order for the eye to stay healthy, it must remain
moist. The lacrimal gland, a specialized structure located
under the outer one third of the upper eyelid, helps
to make tears. Each time you blink, your eyelid spreads
tears over the surface of the eye and pumps excess tears
towards ducts in both the upper and lower eyelids. These
ducts then drain the tears into your nose.
Lacrimal Obstruction is usually due to an infection with
the "tear pipe" located in the nose, causing
swelling in the inner corner of the eyelid. Approximately
seven percent of infants are born with a congenital obstruction
of their tear drainage system (the lacrimal duct) in
either one or both eyes. This percentage is even higher
in premature babies. In most infants, the obstruction
is caused by a membrane at the base of the tear duct
just before the duct enters the nose.
Obstruction of the tear duct will cause tearing or watering
of the eye because the tears cannot drain properly. Symptoms
of a blocked tear duct include eyelashes that are stuck
together by mucous or an accumulation of tears in one
or both eyes. The tears trapped within the duct may become
infected, causing a painful swelling in the inner corner
of the eyelid.
It is important that excessive tearing or discharge be
examined by an ophthalmologist to determine the cause
of the problem. In some children, excessive tearing may
be due to causes other than tear duct obstruction. In
infants the membrane that causes the obstruction will
usually open on its own within three to four weeks after
birth. If this does not occur, your physician will recommend
treatment to open the blockage.
Initial treatment involves massaging the area over the
affected tear sac (located under the skin between the
eye and nose) to force the tears and mucous from the
sac, hopefully pushing open the membrane causing the
obstruction. In infants this massage requires the active
involvement of the parent, as it must occur frequently.
Massage is generally continued until the tearing resolves.
Antibiotic drops or ointments may also be prescribed
by the physician.
If the obstruction is still present, it may be necessary
to open the tear duct by probing and irrigation. In infants
this is most commonly performed between six months and
one year of age. The probing is done by passing a thin
probe down the tear drainage system in an attempt to
open the blockage. There is minimal pain associated with
this procedure. After the probing, there may be some
brief blood staining of the tears or a slight nosebleed.
Antibiotic drops or ointments may be prescribed. Unfortunately,
blockages may recur in spite of probing. If the tearing
persists, then a silicone tube may be paced down the
duct to keep the tear draining system open. The tubes
are tiny and generally imperceptible and usually remain
in place for twelve months to prevent the obstruction
Treatment depends on the exact cause. If the tear drainage
system in blocked, surgery to open the blockage may
be necessary. The type of surgery depends on the location
of the blockage. For example, it may be necessary to
make an additional opening from the lacrimal sac into
the nose, a procedure known as a dacryocystorhinostomy
or DCR. If the problem is dry eyes, artificial tear
replacement or even closure of the tear drainage (puncta)
may be helpful.