Before making a diagnosis of naso-lacrimal duct obstruction, causes of excess watering such as allergic conjunctivitis and blepharitis will be excluded.
Naso-lacrimal duct obstruction may be a congenital or an acquired problem. In small children the tear duct, which runs from the eye to the nose is present, but not open. Babies present with sticky eyes, with frequent episodes of recurrent conjunctivitis. The vast majority (90%+) get better with simple measures such as massage over the tear duct. Sometimes there is a frustrating wait up to the age of 18 months or so for this to occur. If the situation persists some form of intervention will be required.
In adults the most common cause of an obstructed tear duct is due to ageing changes. Other causes can be due to previous infections, lid malposition (see under ectropion) or injury to the tear duct area.
In both adults and children, the obstruction of the tear duct may lead to dacryocystitis. This is an inflammation and infection of the obstructed tear sac resulting in an abscess. It is painful, and an enlarging lump appears over the inner area of the lids. The infection will not settle until the sac has been drained. Typically this can be achieved as an outpatient procedure under local anaesthetic. The relief is immediate. Oral antibiotics will be required.
Surgery will be required to prevent recurrent episodes, which are sure to occur if left untreated.
Tear Duct Surgery
The aims of the surgery are to bypass the tear duct obstruction and to allow the tears to drain into the nose by an alternative route. This involves removing some bone from the side of the nose and creating a channel for the tears to flow down. The procedure can be done externally with a small incision along the side of the nose. This generally heals with minimal scarring.
Alternatively the procedure may carried out using a telescope through the nose. This has the advantage that there is no scar on the skin surface. The success rates is slightly less with external surgery, however this can be revised if needed.
lacrimal sac becoming inflamed and distended.
Surgery is the only way to cure this problem.
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