What is Tear Duct Obstruction?

Tears help moisten the eyeball and keep the eye clean and clear. After washing the surface of the eye, the tears travel through a duct to the nose and are continuously drained this way. If this duct becomes blocked for any reason, the tear drainage becomes problematic. This can occur in two forms: acquired and congenital.

• Acquired: This occurs due to an infection.
• Congenital Tear Duct Obstruction: It usually occurs between the ages of 3 to 12 weeks, appearing as continuous tearing from one eye, and in rare cases, both eyes. The cause of this obstruction is a membrane left at the end of the tear duct near the nose. This condition may be confused with conjunctivitis, but it should be noted that in congenital tear duct narrowing, symptoms are delayed, and there is typically no purulent discharge in the corner of the eye.

Symptoms of Tear Duct Obstruction or Infection:

• Continuous tearing from one or both eyes
• Mucus and pus discharge instead of tears from the tear duct
• Pain, redness, and swelling under the eye
• Redness and swelling of the tear duct
• Redness of the white part of the eye around the tear duct
• Diagnosis is made by a physician based on clinical examination and the symptoms mentioned.

Treatment of Tear Duct Obstruction:

In 95% of children, the tear duct opens naturally before the age of one. Treatment options include non-surgical and surgical methods.

• Non-Surgical Treatment: Includes monitoring the patient, massaging the tear sac, and using topical antibiotics. To massage, wash your hands and place your index finger on the inner corner (toward the nose) of the eye, applying gentle pressure downward. You may be asked to use warm compresses. If an infection is present, using an antibiotic ointment or drop can be beneficial. However, antibiotics will not resolve the obstruction.

If the tear duct obstruction does not resolve with these treatments after several months or if a severe infection occurs, surgical intervention (probing) may be required. This procedure takes about 10 minutes, and a thin metallic probe is passed through the closed tear duct to relieve the obstruction.

Tear duct obstruction can only be treated with probing or “sondage” in children under two to three years of age; in older children and adults, probing is used only for diagnostic purposes and is not recommended for treatment.

If the obstruction is complete, surgery to open the tear sac and connect it to the nose is necessary.

In adults, the DCR (Dacryocystorhinostomy) procedure is performed, which opens the tear duct into the nose.

The DCR procedure can be performed through an external incision (on the skin) or endoscopically through the nose.

Post-Operative Care after DCR Surgery:

• Use cold compresses if there is bleeding after the surgery.
• After the surgery, the patient should rest in a semi-sitting position.
• The nasal packing will be removed the day after the surgery by the doctor or nurse.
• After 12 hours, warm compresses can be used (under the guidance of the treating physician).
• If there is excessive bleeding, consult your doctor or visit the eye emergency center.
• You can clean the area around the eyes with warm water and baby shampoo (under the guidance of the treating physician).
• You can shower the day after the surgery.
• Follow the prescribed eye drops and oral medications as directed by your doctor.
• For suture removal, visit your doctor one week after surgery.
• The silicone tube inside the tear duct will be removed a few months after surgery (as per the treating physician’s instructions).
• Rinse the inside of the nose with diluted saline solution.
• Avoid vigorous coughing or sneezing for one week after the surgery.

How to Use Eye Drops Properly:

To use eye drops, wash your hands thoroughly with soap and water, tilt your head back slightly, pull down your lower eyelid with your index finger to create a small pocket, and place a drop into the pocket. Avoid touching the dropper tip to your hands or eyelids. After applying the drop, gently close your eyes for 2-3 minutes. If you need to apply two different drops within an hour, wait 5-10 minutes between them.

(Wishing you a speedy recovery)

Farvardin Specialized Surgery Center