About Blocked Tear Duct:

Blocked tear ducts is an eye condition that results in watery eyes. When your tear ducts are blocked, tears cannot drain out of your eyes. As a result, the tears build up in your eyes, making them very watery. This condition is most common in newborns, young children, and older people (above the age of 60).

Causes:

The block in the tear duct can be caused by:

  • Ageing – as we get older, the tear duct openings may get narrower
  • Inflammation
  • Eye injury
  • Tumors

In some cases, newborn babies may be born with unopened tear ducts.

The symptoms are:

  • Lots of tears or discharge from the eyes
  • Swelling near the inner corners of the eye (where the tear ducts are located)
  • Inflammation
  • Eye redness

Blocked tear ducts can affect your quality of life. You must get them treated, especially if you have other eye conditions. Luckily, the condition is treatable. The exact treatment will depend on what caused the blocked tear duct. It could include:

  • Medication to treat an infection
  • Special tear duct massage (mainly for babies)
  • Probing – using a thin rod to open the tear ducts in children
  • Tubes to drain the tears through the nose

A very common surgery is dacryocystorhinostomy (DCR). It is the only way to treat the tear duct block completely, since medications and massages may only treat the underlying cause without fixing the block. This surgery can reopen the tear duct. During the surgery, you will be given an anesthetic so you don’t feel anything. There are two main types of DCR: External and Laser.

External DCR:

External DCR is when the surgeon makes a small cut near the swelling on the side of your nose. A small tube may be inserted to connect the tear duct to the nose cavity. The cut is then sealed with a few stitches.

Laser DCR:

This is a newer method. A very thin tube is poked through the blocked opening of the tear duct until it reaches the bone between the tear duct and the nose. A tiny wire is passed through this tube. Once the wire reaches the bone, a strong laser is turned on. This laser cuts through the bone, creating a new opening for the tear duct.

External vs. Laser DCR:

Both have their advantages and disadvantages.

External DCR Laser DCR
Surgery takes longer to complete Surgery only lasts a few minutes
May leave a small visible scar on the side of the nose No need for stitches, so there is no scar or external wound
A small pack is placed in the nose for a day . This can be uncomfortable Packs are not placed in the nose.
Very good results Relatively new method with inconsistent results. Lower success rate
General anesthetic or local anesthetic injection is given. During general anesthetic, you will be asleep Local anesthetic cream is applied. You will be awake, but will not feel pain
Second surgery is rarely needed Second surgery is often required

What causes the watering and discharge?

The eyes water because the flow of tears is blocked somewhere in the tear ducts. If you have discharge, it is a sign that the blockage is caused by infection.

How can it be treated?

The only way to treat it is by surgically opening the tear duct.

Is DCR surgery necessary?

Yes. Surgery is essential and must be done sooner or later. However, if any other eye surgery is planned (like retina or cataract surgery), then the tear duct DCR surgery must be done as soon as possible.

What happens if we don’t treat it?

If left untreated, watering and discharge will persist. This increases the risk of infections. It also raises the chance of repeated episodes of pain and swelling near the eye.

Which is better – external or laser DCR?

In general, there are advantages and disadvantages to each. External DCR takes longer, is less comfortable and may leave a small scar. However, it yields better results and rarely requires a second surgery.

Does the tube placed during DCR cause any side effects?

The tube is made from a safe material. It does not cause irritation or any other side effects.

When should the stitches and tube be removed?

Some stitches do not need to be removed. Others will be removed within 7-10 days. The tube is left in place for a few months, as advised by the doctor. If all goes well, it is normally removed after 3 months.

Will there be a scar?

Yes. External DCR does create a small scar on the side of the nose. However, this usually fades with time. It is not very noticeable after the wound has healed.

Is probing a surgery or a procedure?

Probing is not a surgery. It is a small procedure where the doctor passes a thin rod through the tear duct to try to open it up. It only takes a few minutes and the child can go home the same day. The child will be under general anesthesia during the procedure.

Is there any risk to the child during general anesthesia?

Although there is always some risk, probing is a short procedure so the child will only be unconscious for a few minutes. The anesthetist will also be with the child during the entire procedure. The child will be well looked after, so there is no cause for concern.

Probing was already done once. Why is it being repeated?

Probing is only an attempt to open up a tear duct that was blocked at birth. There is no guarantee that it will work on the first try. If the block is a soft tissue, it is easy to remove and open the tear duct. In some cases, the tear duct may be blocked by a harder tissue, like bone. This makes it harder to open the duct with probing. For some hard tissues, a second probing attempt may open the block. But for bone, DCR surgery with intubation is needed.

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