Definition

Under normal circumstances, tears are produced by the lacrimal glands, which are located at the top and bottom of the eye. These tears are directed from the lacrimal glands to the surface of the eyeball. After moistening the eyeball’s surface, the tears drain through an opening in the corner of the eye, known as the puncta. The puncta allow the tears to pass into the canaliculus, which is a channel leading to the lacrimal sac, a temporary reservoir for tears. From the lacrimal sac, the tears flow through the nasolacrimal duct into the nose, where they are reabsorbed by the body.

Dacryostenosis is a condition in which one of the tear channels becomes blocked, preventing the proper drainage of tears. This blockage may occur due to a partial or complete obstruction in the tear drainage system. In adults, dacryostenosis may result from accidents, infections, or tumors. The impaired tear flow can cause irritation of the eyeball’s surface.

Congenital dacryostenosis, or blocked tear ducts in newborns, occurs in approximately 1.2% to 20% of cases. It is the leading cause of excessive tearing in infants and young children. Research indicates that about 20% of healthy infants experience dacryostenosis at least once within their first year. Acquired dacryostenosis in adults can lead to watery eyes and swelling at the corners of the eyes. It is reported in 3% of clinic visits, with 37 cases per 100,000 visits annually. Dacryostenosis is more frequently observed in older individuals and women.

Causes

• Congenital: Dacryostenosis is common in newborns, often due to incomplete formation of the tear ducts at birth or an abnormality in the shape of the tear drainage system. In some cases, residual tissue attached to the duct impairs tear drainage.
• Age: As people age, the tear drainage openings (puncta) may narrow, leading to blockages.
• Infection or inflammation: Infections or inflammation affecting the eyes and tear drainage system can result in a blockage. Repeated dacryocystitis may alter the tear duct structure, hindering drainage.
• Accidents: Facial trauma or accidents may damage the bone or injure the tear drainage system, disrupting tear flow. Small particles, such as dust or dead skin cells, can also block the ducts.
• Tumors: Tumors near the face, nose, or drainage system can apply pressure on the tear ducts, causing blockages.
• Eye drops: Prolonged use of eye drops, particularly for glaucoma treatment, may contribute to tear duct blockages.
• Cancer treatments: Cancer therapies such as chemotherapy or radiation can damage the eye’s drainage system, resulting in obstruction.

Risk Factors

• Elderly individuals are more susceptible to dacryostenosis.
• Eye inflammation: Persistent eye inflammation increases the risk of developing dacryostenosis.
• Surgery: Surgical procedures involving the eyes, nose, sinuses, or eyelids may injure the tear ducts, leading to blockages.
• Glaucoma: Regular use of antiglaucoma medications, particularly in eye drop form, elevates the risk of dacryostenosis.
• Previous cancer treatment: Radiation or chemotherapy treatments, especially targeting the facial area, raise the likelihood of developing blocked tear ducts.

Symptoms

Individuals with dacryostenosis may exhibit several symptoms, including:

• Persistent watery eyes
• Eye redness
• Recurrent conjunctivitis
• Pain and swelling in the inner corner of the eye
• Significant dry eye discharge
• Pus or sticky discharge in the eye
• Blurred vision

Diagnosis

To diagnose dacryostenosis, a physician will inquire about your symptoms, particularly complaints of watery eyes and vision problems in adults. The doctor will also assess your visual acuity and check for signs of infection, such as redness, swelling, and pain around the eyes. If you have had prior eye infections, it is important to inform your doctor. Diagnosis is usually made based on anamnesis and a physical examination, which involves inspecting the eyelids, puncta, and conjunctiva. The physician may also gently massage the lacrimal sac to stimulate tear flow through the puncta.

Additional diagnostic tests include:

• Tear drainage test: This test evaluates the time it takes for tears to drain. A dye is placed in the eye, and if it remains after five minutes, dacryostenosis may be present.
• Irrigation: The physician flushes saline through the tear ducts to assess drainage. A probe may also be used to check for mechanical blockages and, in some cases, can help treat dacryostenosis.
• Imaging: X-rays, CT scans, or MRIs may be conducted as needed.

Management

Medical Treatments

Treatment depends on the underlying cause of dacryostenosis, and you may require multiple treatments. Potential treatments include:

• Antibiotics: Prescribed to treat any infection in the eyes.
• Watch-and-wait: In infants, blocked tear ducts often resolve on their own due to immaturity of the tear system. Gentle massage around the eyes may assist tear flow. For injuries to the face, doctors may wait for full recovery, after which tear flow often normalizes.
• Dilation and probing: The physician may enlarge the tear ducts to facilitate better tear drainage.
• Catheter: If other treatments are unsuccessful, a catheter may be used to widen the duct.

Surgery

The surgical procedure for dacryostenosis is known as dacryocystorhinostomy, which creates a new pathway for tear drainage into the nose. The specific approach depends on the doctor's evaluation and indications. Following surgery, decongestant sprays and eye drops will be prescribed to reduce infection and inflammation. A follow-up appointment will be necessary in 6–12 weeks to remove the stent.

Home Care

Massaging the eye area 2–3 times daily can help alleviate symptoms.

Complications

Poor tear drainage can lead to tear accumulation in the eye, fostering the growth of bacteria, fungi, and viruses that cause inflammation and recurrent infections. If left untreated, more severe conditions like endophthalmitis or orbital cellulitis may develop. In children, dacryostenosis can lead to refractive issues. Around 10% of children with blocked tear ducts may develop anisometropia, with or without amblyopia.

Prevention

To lower your risk of dacryostenosis, treat any eye inflammation or infection promptly. You can also take the following precautions to reduce your risk of eye infections:

• Practice the WHO’s 5 steps of handwashing, especially after activities or contact with individuals with conjunctivitis.
• Avoid excessive touching or rubbing of your eyes.
• Regularly change your eyeliner and mascara, and avoid sharing eye makeup.
• Keep contact lenses clean as per your eye doctor's recommendations.
• Maintain overall health by eating nutritious food, getting enough rest, and avoiding respiratory infections, which can cause nasal swelling that interferes with tear flow.

When to See a Doctor?

Seek medical attention if you experience recurrent dacryostenosis or if the condition persists for several days.

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