Blocked Tear Duct in Adults: Causes, Symptoms, Treatment, Surgery

A block in the tear duct usually refers to blockage in tear’s coming out from your eyes. It results in eyes watering, irritation in the eyes. Blocked tear duct in adults is mostly caused because of the thickening of tear duct lining. Blocking of tear duct is common in infants or new born babies and gets cured automatically over a period of time. The blocked tear duct in adults is due to an infection or tumor in the eye.

Blocked tear duct in adults is curable and the treatment is based on the intensity of the problem, reason for blockage, the person’s age and other factors.

The blocked tear duct in adults is usually caused by the following reasons. They are:

If a tear duct lining becomes thick, the duct becomes narrow with swelling and inflammation. It is known as primary acquired nasolacrimal duct obstruction (PANDO). It is observed in women who are aged above 40.

Nasal issues like:

• Unusual growth of tissues or tumor in the nose.
• Uncontrolled increase in size of nasal bones.
• Deformed bone or cartilage present between the nostrils.

Sinus issues like:

• An acute sinus infection.
• Complications of a sinus operation.
• Swelling or unusual increase in sinus.

Issues preceding a surgery for the sinus or nasal cavities such as:

• Rectifying a damaged cartilage in the face.
• Nasal surgery resulting in deformation or change in shape of nose structure.

Other causes of blocked tear duct in adults:

• A lacrimal stone formed inside the tear duct.
• An intermittent cheekbone which puts pressure over the tear duct.
• Damage to eye socket bones.
• Infections causing inflammation and burning sensation to the eyelid. This infection may cause scar to the eyelids.
• Nasal tumors or sinus tumors may develop along the tear drain system, and block it while they grow bigger.
• Sometimes the topical medications, like the ones treating glaucoma, upon prolonged usage, may result in a blocking the tear ducts.
• Also, a tear duct block may be a side effect of radiation for cancer treatment.

Signs and symptoms to identify a blocked tear duct in adults caused by any infections are:

• Superfluous watering of eyes.
• Recurrence of conjunctivitis.
• Persistent eye diseases.
• Inflammation near the extreme sides of the eye.
• Discharge of pus or mucus from the eyelids of the eye.
• Blurred vision.

Continuous watering of eyes or persisting irritability, causing infections are some out the symptoms of a tear duct blockage in the eye. It is recommended to consult a doctor if this does not subside by itself as tumors can cause blocked tear duct in adults.

Blocking in tear ducts may increase the chances of occurring because of the following factors:

• Women aged above 40 are more prone to develop a blocked tear duct due to aging issues.
• Conjunctivitis or continuous eye infections and inflammations may result in a blocked tear duct in adults.
• Earlier surgeries done to eyes, eyelids or nasal cavities may cause deformities in the duct system, resulting in a blocked tear duct in later stages.
• Topical medicines used for eye disorders like glaucoma or anti-glaucoma result in a higher occurrence of a tear duct blockage.
• Cancer treatments like chemotherapy or radiations focused on face or head may result in forming a tear duct blockage.

An eye examination to see the running of tears & testing inside nasal cavity for any structural deformities are main tests to determine a blocked tear duct in adults. If a tear duct blockage is confirmed, further examinations may be done to identify its location.

Few examinations to determine the presence of a blocked tear duct in adults are:

• A fluorescein dye disappearance test or a tear drainage test. This is a test to determine how rapidly your tears are running down the eyes. Each eye is laced with a drop of special dye. After few minutes of blinking, if there is notable amount of dye remaining in the eye, it is a case of tear duct blockage.
• Saline may be flushed into the tear drain system to inspect how the eye is draining the tears. Tiny probe is inserted through drain holes the corner of eye lids to identify any blockages. If there is a narrowed drain tube this system will resolve the issue immediately.
• Dacryocystography or Dacryoscintigraphy which is an Eye imaging test is another method. The corners of eye lids through the tear drain system are laced with a contrast dye X-ray, CT Scan or MRI techniques to locate the blockage and its reason.

Identifying the cause of blocked tear duct in adults will help in determining the right treatment. At times, multiple treatment options are considered by the doctors to cure a blocked tear duct in adults.

Antibiotic eye drops are prescribed by the doctor in case of any infection or its symptoms.

A surgery is recommended if any malignancy or swelling is identified to be the cause of a blocked tear duct in adults. Treatments to shrink the tumor without surgery may also be considered.

If the cause is a non-tumor blocked duct, the treatments vary from an observation to a surgery.

Conservative treatment can help for the problem of blocked tear duct in adults. A facial injury, resulting in blocked tear ducts may require conservative treatment. It means, post the surgery, the inflammation will subside and gradually result in diminishing of the blocked tear ducts. It takes some time to heal and may require few months’ after injury.

Minimally invasive treatments can aid in getting rid of blocked tear duct in adults. Minimally invasive treatments are for those adults with partially blocked ducts or for adults who suffer from a shrinking tear drain system.

1. Balloon Catheter Dilation for Treating Blocked Tear Duct in Adults

   Blocked tear duct in adults can be treated by balloon catheter dilation. This technique helps in opening up blockages acquired through scarring, swelling or other such ailments. Local anesthesia is given to the person and a catheter with a deflated balloon on the tip is sent inside the lower nasolacrimal duct in the nose.

   The balloon is inflated and deflated using a pump, as it helps in moving the balloon to other locations in the drain system. Catheter dilation is further potent for new born babies and toddlers, but can also be implemented in adults with minimal or partial blockage.

2. Intubation to Treat Blocked Tear Duct in Adults

   Blocked tear duct in adults can be cured by intubation method. A local or general anesthesia is applied in this method. A slim tube of silicone is sent through corner of eye lids through the tear drain system inside the nasal cavity. Small portion of this tube will be visible near the extreme side of the eye, and this tube is left inside the patient for almost three months or a little beyond that, before removing it. Swelling and inflammation may occur because of the presence of tube for longer duration. This method is known as intubation or stenting.

Surgery option is recommended for young adults or adults who have blocks inside the drain system. It is also done to infants who are not cured using lesser invasive method.

Dacryocystorhinostomy is a common surgery, to treat the blocked tear duct in adults. In this procedure a passageway is reconstructed for tears to flow easily through the drain system. Initially a local anesthesia is given if the surgery is done as a part of outpatient (OP) procedure

The physician initially accesses the patients tear drain system and later creates a direct connection between the lacrimal sac and nose. The connection between lacrimal sac and nose bypasses the nasolacrimal duct where in most blockages occur. Generally a stent or intubation is embedded in the alternate path created during the healing time and are removed after three months’ time post-surgery.

The steps involved in Dacryocystorhinostomy procedure vary as per the degree of blockage, experience of surgeon and their choice in operating procedures.

• External Dacryocyostorhinostomy: This is a customary surgical procedure, done to clear a blocked tear duct in adults. General anesthesia is given to the patient before exerting this procedure. A small opening is done on the side of lacrimal sac. A new connection is established between the lacrimal sac and nasal cavity and intubation is done. This opening is closed with the aid of external stitches.
• Endonasal or Endoscopic Dacryocyostorhinostomy: Bypass can be done with the help of endoscopic instruments without making an opening near the lacrimal sac. The physician makes use of a tiny microscopic camera and inserts it through the duct system. A fiber-optic light is also utilized in this procedure and is inserted from the corner of eye lids to spot the duct area. Through this method, no piercing or scarring occurs. But it has drawbacks too. The success rates are low and the physician should be well trained in carrying out this process.
• Bypass the lacrimal duct system: A bypass procedure may be opted by the surgeon based on the blocking of tear duct. An alternate path is created from the puncta to the nose by bypassing the tear drain system as a substitute to the new route from lacrimal sac to the nose.

Post-surgery of a blocked tear duct, nasal drops and eye drops should be used to avoid further swelling and infections. Stents or intubations which are used to retain the current passage intact may be kept for a period of three months after the surgery as a part of curative methods.