Treatments and drugs

By Mayo Clinic Staff

The cause of your blocked tear duct will determine which treatment is right for you. Sometimes, more than one treatment or procedure is needed before a blocked tear duct is completely corrected.

If an infection is suspected, your doctor will likely prescribe antibiotic eyedrops.

If a tumor is causing your blocked tear duct, treatment will focus on the cause of the tumor. Surgery may be performed to remove the tumor, or your doctor may recommend using other treatments to shrink it.

Treatment options for nontumor-blocked tear ducts vary from simple observation to surgery.

Conservative treatment

Many babies that are born with a blocked tear duct will get better without any treatment. This can happen as the drainage system matures during the first few months of life. It can also happen when the extra membrane in the nasolacrimal duct opens up.

If your baby's blocked tear duct isn't improving, his or her doctor may teach you a special massage technique. Done several times a day, this massage can help open up the membrane that's blocking the flow of tears.

If you've had a facial injury that caused blocked tear ducts, your doctor may suggest conservative treatment. The reason is that as your injury heals, and the swelling goes down, your tear ducts may become unblocked on their own. This usually happens within a few months after the injury.

Minimally invasive treatment

When infants and toddlers need treatment for a blocked tear duct, minimally invasive options are often used. These procedures can also be effective for adults with narrowing of the puncta, or for those who have a partially blocked duct.

  • Dilation, probing and irrigation. This technique works to open congenital blocked tear ducts in most infants. The procedure may be done using general anesthesia in very young babies.

    First, the doctor enlarges the punctal openings with a special dilation instrument, and then a thin probe is inserted through the puncta and into the tear drainage system. The doctor threads the probe all the way out through the nasal opening, sometimes causing a popping noise as the probe pierces through the extra membrane. The probe is removed, and the tear drainage system is flushed with a saline solution to remove any remaining blockage.

    For adults with partially narrowed puncta, a similar procedure may be done in the doctor's office. The tear ducts are flushed and irrigated while the puncta are dilated. If the problem is related solely to a partial narrowing of the punctal opening, this procedure will often provide temporary relief, at least.

    Antibiotic eyedrops may be prescribed for any infections. If irrigation and dilation doesn't work, or if the beneficial effects of the dilation are only temporary, surgery may be necessary to open narrowed puncta. Sometimes, a small incision at the punctal opening may be all that's necessary.

  • Balloon catheter dilation. If your tear ducts are blocked by scarring, inflammation and other acquired conditions, balloon catheter dilation can help open up your blockage. The procedure is done using general anesthesia, and then a tube (catheter) with a deflated balloon on the tip is threaded through the lower nasolacrimal duct in your nose.

    A pump is used to inflate and deflate the balloon a few times, sometimes moving it to different locations along the drainage system. This procedure is more effective for infants and toddlers, but also may be used in adults with partial blockage.

  • Stenting or intubation. This procedure is usually done using general anesthesia. A thin tube, made of silicone or polyurethane, is threaded through one or both puncta in the corner of your eyelid. These tubes then pass through the tear drainage system into your nose. A small loop of tubing will stay visible in the corner of your eye, and the tubes are generally left in for about three months before they're removed. Possible complications include inflammation from the presence of the tube.

Surgery

Surgery is usually recommended for older children and adults who need treatment. Surgery is also an option for infants and toddlers who haven't been successfully treated with less invasive methods.

The surgery that's commonly used to treat blocked tear ducts is called dacryocystorhinostomy (DAK-rye-oh-sis-toe-rye-nohs-tuh-me). This procedure reconstructs the passageway for tears to drain out through your nose normally again. First, you're given a general anesthetic, or a local anesthetic if it's performed as an outpatient procedure.

The surgeon accesses your tear drainage system, and then creates a new, direct connection between your lacrimal sac and your nose. This new route bypasses the duct that empties into your nose (nasolacrimal duct), which is the most common site of blockage. Stents or intubation typically are placed in the new route while healing occurs, and they are usually removed about three months after surgery.

The steps in this procedure vary, depending on the exact location and extent of your blockage, as well as your surgeon's experience and preferences.

  • External. An external dacryocystorhinostomy is a commonly used surgical method of opening a blocked tear duct. While you're under general anesthesia, your surgeon makes an incision on the side of your nose, near where the lacrimal sac is located. After connecting the lacrimal sac to your nasal cavity and placing a stent in the new passageway, the surgeon closes up the skin incision with a few stitches.
  • Endoscopic or endonasal. The same bypass procedure can be performed using endoscopic instruments. Instead of making an incision, the surgeon uses a microscopic camera and other tiny instruments inserted through the nasal opening to your duct system. Sometimes, a fiber-optic light is inserted into your puncta to illuminate the surgical area. The benefits of this method are that there's no incision and no scar. The drawbacks are that it requires a surgeon with special training, and the success rates aren't as high as with the external procedure.
  • Bypassing the entire lacrimal duct system. Depending on the type of blockage, your surgeon may recommend a reconstruction of your entire tear drainage system (conjunctivodacryocystorhinostomy). Instead of creating a new channel from the lacrimal sac to your nose, the surgeon creates a new route from the conjunctiva near the inside corner of your eyes to your nose, bypassing the tear drainage system altogether.

Following surgery for a blocked tear duct, you'll use a nasal decongestant spray as well as topical eyedrops to prevent infection and reduce postoperative inflammation. After three to six months, you'll return for removal of any stents used to keep the new channel open during the healing process.

Feb. 13, 2013