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Tear Duct Blockage

Tearing Duct Blockage

The lacrimal gland in the upper eyelid produces tears which constantly lubricate the eye and keep it healthy. It responds to eye irritation and emotion by producing extra tears.

Tears drain through small openings (the puncta) on the inside corner of each eyelid, draining through a small canal (canaliculus) to the lacrimal sac whence they drain to the tear (nasolacrimal) duct into the back of the nose.

Watery eyes with tear overflow occurs with excess tear production or reduced tear drainage.

Reduced tear drainage can be due to:

  • Blocked tear duct
  • A malpositioned eyelid or punctum
  • Infections, especially of the lacrimal sac

Excess tear production can be caused by:

 

  • Foreign body in the eye
  • Wind, smoke, fumes
  • Infections, allergic reactions
  • Faulty blinking
  • Emotion
  • Dry eyes

Dacryocystorhinostomy

(DCR)

Tears drain from the eye into the nose via the tear sac and duct. Blockage of the tear duct may cause watery eye and infection. Treatment is the bypass operation DCR. This connects the tear sac to the nose allowing drainage above the blocked tear duct.

Punctal Snip

The punctum is a tear duct opening, there are 2 each side. The lower one drains 80% of tears. If this is blocked or narrow tear overflow may occur.

A punctal snip opens it to restore flow.

Tearing in infants

Overflow tearing and chronic eye infections in infants from birth is commonly due to incomplete development of the tear drainage system. A membrane persists at the bottom end of the tear duct. This blockage prevents tear drainage causing tear overflow. It also traps germs which would normally flow through causing infections.

95% of congenital tear duct blockages open spontaneously by 12 months of age. In the meantime antibiotic drops can be used to control infections. It is advisable to wait 12 months as general anaesthesia is much easier at this age.

If the blockage persists after 12 months then a probing can be done. Under general anaesthetic in day surgery a probe is pushed through the membrane. This is effective in 95% of cases.

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