Blocked Tear Duct – Diagnosis and Treatment
Diagnosis
A healthcare provider starts by asking about your symptoms. Then, the provider examines your eyes closely.
They look for extra tearing, redness, or discharge. Sometimes, the provider also checks inside your nose for blockages or unusual structures that might cause drainage problems.
Common steps in diagnosing a blocked tear duct include:
| Test Name | What It Does |
|---|---|
| Tear Drainage Test | Checks how fast tears leave the eye. |
| Irrigation and Probing | Finds and sometimes clears blockages. |
| Imaging | Pinpoints the location and cause of blockage. |
- Tear Drainage Test: The doctor places a special dye on your eye. After a few minutes, they check how much dye remains. If a lot of dye is still present, tears may not be draining well, which could mean a blockage.
Irrigation and Probing: The doctor gently washes your tear drainage system with saline water. They may use a thin instrument to check if fluid moves easily and to find any blocked spots.
Imaging: If the problem is hard to find, the doctor might use imaging techniques like X-rays, CT, or MRI scans. They add a contrast dye to your tear ducts to show where the blockage is and what might be causing it.
If the doctor notices an infection during these exams, they address it as part of the diagnosis.
Treatment
Surgical Procedures to Treat Tear Duct Blockages
Doctors may recommend surgery when other treatments do not solve a blocked tear duct. They choose the specific approach based on your age, the cause of the blockage, and the structure of your tear drainage system.
What Conditions May Need Surgery?
- Blocked Tear Ducts in Adults: Aging, injury, or inflammation can block the drainage system.
- Tumors: If a growth causes the blockage, doctors may remove it during surgery.
- Repeated Infections or Complications: Surgery may be needed when other treatments have not helped.
Surgeons often perform dacryocystorhinostomy on adults when other treatments have failed. The main goal is to create a new route for tears to drain from your eye into your nose.
There are two main ways to perform this surgery:
External DCR:
- The surgeon makes a small cut on the side of your nose, near the corner of your eye.
- They find the lacrimal sac and create a direct opening between the sac and the nasal passage.
- The surgeon may place a tiny tube, called a stent, in the new passage to keep it open during healing.
- They close the skin with a few stitches.
Endoscopic or Endonasal DCR:
- The surgeon uses a small camera and fine instruments inserted through your nose to create an opening from the inside.
- No cut is made on the outside, so you will not have a visible scar.
- The choice between external and endoscopic methods depends on the surgeon’s experience, the exact site of the blockage, and your preferences.
DCR Comparison Table
| Aspect | External DCR | Endoscopic DCR |
|---|---|---|
| Incision Location | Side of nose | Inside nasal passage |
| Scarring | Possible, small | None |
| Use of Stent | Common | Often |
| Success Rate | Slightly higher | Good, but may be lower |
| Anesthesia Type | General or local | General or local |
| Visibility of Stitches | Yes | No |
Anesthesia and Safety
Doctors usually use general anesthesia for surgery, especially in children or if the procedure is extensive. Some adults may have surgery under local anesthesia if the case is simple and done as an outpatient.
Before the operation, the anesthesiologist reviews your health history and discusses the safest option. The surgical team monitors you closely during surgery for any complications.
Recovery and Aftercare
After surgery, doctors usually prescribe nasal sprays and eye drops. These medicines help with healing, prevent infection, and reduce inflammation.
A soft stent or tiny tube may stay in place to keep the new duct open during recovery. The doctor usually removes this tube in the office about 6 to 12 weeks later, depending on your healing.
Most people return to normal activities after a short rest at home. Avoid blowing your nose hard, straining, or rubbing your eye during recovery.
Risks of Surgery
All surgeries carry some risks, including:
- Infection at the surgical site
- Bleeding or bruising
- Scarring, especially with external techniques
- Stent-related irritation if a tube is used
Doctors explain these risks and tell you how to watch for problems at home.
| Key Aspect | Detail |
|---|---|
| Main Goal | Create a new path for tears to drain |
| Anesthesia | General or local, based on patient and method |
| Recovery Tools | Nasal spray, eye drops, tube may be present |
| Removal of Tube | Usually 6–12 weeks after surgery |
| Return to Normal Activities | Shortly after initial healing |
Alternatives Attempted Before Surgery
Doctors often try other treatments before recommending surgery, especially for children. These options include:
- Gentle massage of the duct area (mainly for babies)
- Probing the duct with a thin instrument, often under anesthesia for children
- Flushing or irrigating the duct with fluid to clear a partial blockage
- Balloon catheter dilation to widen the duct
- Temporary stent or tube placement (intubation)
These methods are usually less invasive than surgery and are considered first for young children, people with recent injuries, or those with partial blockages.
Getting Ready for Your Visit
Steps to Take Before Your Appointment
To prepare for your appointment, stay organized. Create a checklist to make your visit more productive.
- Write down all symptoms, even those that do not seem related to your eyes.
- List every medication, vitamin, and supplement you take, including doses and eye drops.
- Prepare a set of questions for your provider.
Some helpful questions include:
| Question | Purpose |
|---|---|
| What could be causing my symptoms? | To understand possible sources |
| Are other causes possible? | To rule out different problems |
| Should I get any tests? | To plan the next steps |
| How long is this likely to last? | To set expectations |
| What treatment options do you recommend? | To compare choices |
| What side effects should I watch for? | For safety reasons |
| Could this be linked to another health issue? | To spot related concerns |
| What happens if I do nothing? | To learn about risks |
Bringing this information helps your eye specialist or ophthalmologist assess your situation carefully.
Questions Your Provider May Ask You
During your visit, the eye doctor will likely ask detailed questions to understand your symptoms and medical history.
You can expect questions such as:
When did your symptoms start?
Are the symptoms constant, or do they come and go?
Does anything help your symptoms?
Have you used any eye drops for this problem?
Have you had any surgeries on your eyelids or eyes?
Have you ever had injuries, facial surgery, or radiation treatments?
Do you have any nerve conditions, such as Bell’s palsy?
Have you ever been told you have a thyroid problem?
Do you have diabetes or any long-term skin problems like eczema?
Are you currently wearing contact lenses or have you used them before?
If you know what questions the doctor might ask, you can prepare answers or bring notes. This preparation can help your visit go more smoothly.
