To diagnosis your condition, your doctor talks with you about your symptoms, examines your eyes and does a few tests. He or she will also examine the inside of your nose to determine if any structural disorders of your nasal passages are causing an obstruction. If your doctor suspects a blocked tear duct, he or she may have you undergo other tests to find the location of the blockage.
Tests used to diagnose a blocked tear duct include:
- Tear drainage test. This test measures how quickly your tears are draining. One drop of a special dye is placed on the surface of each eye. You may have a blocked tear duct if after five minutes most of the dye is still on the surface of your eye.
- Irrigation and probing. Your doctor may flush a saline solution through your tear drainage system to check how well it's draining. Or he or she may insert a slender instrument (probe) through the tiny drainage holes at the corner of your lid (puncta) to check for blockages. In some cases this probing may even fix the problem.
- Eye imaging tests. For these procedures, a contrast dye is passed from the puncta in the corner of your lid through your tear drainage system. Then X-ray, computerized tomography (CT) or magnetic resonance imaging (MRI) images are taken to find the location and cause of the blockage.
Your treatment depends on what's causing the blocked tear duct. You may need more than one approach to correct the problem. 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.
- Medications to fight infection. If your doctor suspects an infection is present, he or she may prescribe antibiotic eyedrops or pills.
Watch-and-wait or massage. Babies born with a blocked tear duct often get better without any treatment. This can happen as the drainage system matures during the first couple months of life. Often a thin tissue membrane remains over the opening that empties into the nose (nasolacrimal duct). If your baby's blocked tear duct isn't improving, his or her doctor may teach you a special massage technique to help open the membrane.
If you've had a facial injury that caused blocked tear ducts, your doctor may suggest waiting a few months to see if the condition improves as your injury heals. As the swelling goes down, your tear ducts may become unblocked on their own.
Dilation, probing and flushing. For infants, this technique is done under general anesthesia. The doctor enlarges the punctal openings with a special dilation instrument and inserts a thin probe through the puncta and into the tear drainage system.
For adults with partially narrowed puncta, your doctor may dilate the puncta with a small probe and then flush (irrigate) the tear duct. This is a simple outpatient procedure that often provides at least temporary relief.
- Balloon catheter dilation. If other treatments haven't worked or the blockage returns, this procedure may be used. It's usually effective for infants and toddlers, and may also be used in adults with partial blockage. First the patient is given a general anesthetic. Then the doctor threads through the tear duct blockage in the nose a tube (catheter) with a deflated balloon on the tip. He or she inflates and deflates the balloon a few times to open the 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.
The surgery that's commonly used to treat blocked tear ducts is called dacryocystorhinostomy (DAK-ree-oh-sis-toe-rye-nohs-tuh-me). This procedure opens the passageway for tears to drain out your nose again. First you're given a general anesthetic, or a local anesthetic if it's performed as an outpatient procedure.
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. With external dacryocystorhinostomy, 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. With this method, your surgeon uses a microscopic camera and other tiny instruments inserted through the nasal opening to your duct system. This method requires no incision so leaves no scar. But the success rates aren't as high as with the external procedure.
Following surgery you'll use a nasal decongestant spray and eyedrops to prevent infection and reduce inflammation. After three to six months, you'll return to your doctor's office for removal of any stents used to keep the new channel open during the healing process.
Preparing for your appointment
You may start by seeing your primary care doctor. He or she may refer you to a doctor who specializes in treating disorders of the eye (ophthalmologist). In some instances, your eye doctor may refer you to someone who specializes in ophthalmic plastic surgery for the eye.
Here's some information to help you get ready for your appointment.
What you can do
Before your appointment make a list of:
- Symptoms you've been having, including any that may seem unrelated to the reason for which you scheduled the appointment
- All medications, vitamins and supplements you take, including doses
- Any eyedrops that you've been taking
- Questions to ask your doctor
For a blocked tear duct, some basic questions to ask your doctor include:
- What's the most likely cause of my symptoms?
- Are there other possible causes?
- Do I need any tests?
- How long will my condition last?
- What treatments are available, and which do you recommend?
- What side effects can I expect from treatment?
- Is this condition related to another medical disorder?
- If I don't have anything done to correct this problem, what are the risks to my vision?
- Do you have any brochures or other printed materials that I can take with me? What websites do you recommend?
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- When did your symptoms begin?
- Do you experience your symptoms all the time, or do they come and go?
- Does anything relieve your symptoms?
- Have you used any eyedrops for this problem?
- Have you had any previous surgery to your eyes or eyelid?
- Have you had facial trauma, injuries, radiation treatment or surgery?
- Have you ever had any facial nerve conditions, such as Bell's palsy?
- Do you have any medical problems, such as diabetes or long-standing skin disorders, such as atopic dermatitis?
- Have you ever been diagnosed with a thyroid disorder?
- Do you use contact lenses? Have you used contacts in the past?