Nasolacrimal Duct Obstruction: Causes and Treatment Options

Nasolacrimal duct obstruction

I have been experiencing involuntary tearing for the past year, along with eye discharge.
A clinic physician diagnosed me with nasolacrimal duct obstruction.
Is the process of clearing the nasolacrimal duct complicated or painful? When is it necessary to perform a dacryocystorhinostomy, and what are the reasons for it? Thank you.

li, 40~49 year old female. Ask Date: 2011/02/14

Dr. Gao Pilin reply Ophthalmology

Hello! The process of probing the nasolacrimal duct involves the use of a local anesthetic for pain relief, and it is generally not very complicated; the pain is usually tolerable for most individuals.
In cases of acquired nasolacrimal duct obstruction, if a lacrimal duct irrigation confirms partial obstruction and the epiphora symptoms are not severe, a nasolacrimal duct probing procedure followed by balloon dilation can be performed to open and expand the obstructed portion of the duct, resulting in significant improvement for about 60% of patients.
For patients with severe obstruction confirmed by lacrimal duct irrigation or those who experience re-obstruction after balloon dilation, a dacryocystorhinostomy (DCR) with silicone tube placement is necessary to create a passage between the lacrimal sac and the nasal cavity, allowing tears to flow from the lacrimal ducts into the nasal cavity.
The success rate of this surgery can reach 95%.
Additionally, a small subset of patients diagnosed with canalicular obstruction may require a conjunctivodacryocystorhinostomy and the implantation of a Jones tube to alleviate symptoms.
However, this procedure requires long-term follow-up due to the potential for displacement of the glass tube.
Acquired epiphora is most commonly caused by acquired nasolacrimal duct obstruction, which predominantly affects middle-aged women aged 45 to 60, possibly related to hormonal changes.
This condition is primarily due to chronic inflammation of the nasolacrimal duct, leading to obstruction and subsequent epiphora.
Other factors, including infection, inflammation, and trauma, can also contribute to secondary nasolacrimal duct obstruction.
It is important to note that if nasolacrimal duct obstruction is left untreated for an extended period, it may lead to acute dacryocystitis and orbital cellulitis.
Wishing you good health!

Reply Date: 2011/02/14

More Info

Nasolacrimal duct obstruction (NLDO) is a condition that affects the drainage of tears from the eyes into the nasal cavity. This obstruction can lead to excessive tearing (epiphora) and discharge from the eyes, which can be quite bothersome. Understanding the causes, treatment options, and the procedures involved can help alleviate concerns regarding the management of this condition.

Causes of Nasolacrimal Duct Obstruction
NLDO can occur for various reasons, including:
1. Congenital Issues: Many infants are born with a blockage in the nasolacrimal duct, which may resolve on its own as they grow.

2. Infections: Conditions such as conjunctivitis or sinus infections can lead to inflammation and blockage of the duct.

3. Trauma: Injuries to the face or eyes can damage the nasolacrimal duct.

4. Age-related Changes: As people age, the duct may become more prone to obstruction due to changes in tissue elasticity and structure.

5. Tumors or Growths: Benign or malignant growths in the area can compress or invade the nasolacrimal duct, leading to obstruction.

6. Chronic Inflammatory Conditions: Conditions such as sarcoidosis or granulomatosis can cause scarring and blockage.

Symptoms
The primary symptoms of NLDO include:
- Excessive tearing
- Eye discharge (which may be crusty)
- Recurrent eye infections
- Discomfort or irritation in the eye

Treatment Options
The treatment for NLDO depends on the severity and underlying cause of the obstruction. Here are some common approaches:
1. Conservative Management: In cases where the obstruction is mild, doctors may recommend warm compresses and gentle massage of the tear duct area to encourage drainage.

2. Dilation and Irrigation: This is a common procedure where a doctor uses a small probe to dilate the nasolacrimal duct and flush it with saline. This can often clear the blockage and is typically performed in an outpatient setting.

3. Balloon Dacryoplasty: If dilation and irrigation are unsuccessful, a balloon catheter may be used to open the duct further. This minimally invasive procedure involves inserting a small balloon into the duct and inflating it to widen the passage.

4. Dacryocystorhinostomy (DCR): In cases where other treatments fail, a surgical procedure called DCR may be necessary. This involves creating a new drainage pathway for tears by connecting the lacrimal sac directly to the nasal cavity. This procedure can be performed using traditional surgical techniques or endoscopically.

Pain and Discomfort During Procedures
Regarding your concern about the pain and discomfort associated with the procedures for clearing the nasolacrimal duct, experiences can vary:
- Dilation and Irrigation: This procedure is generally well-tolerated and may cause mild discomfort, but it is usually not considered painful.

- Balloon Dacryoplasty: Patients may experience some discomfort during this procedure, but it is typically brief and manageable.

- DCR Surgery: This is a more invasive procedure and may involve more discomfort post-operatively. However, anesthesia is used to minimize pain during the surgery.

When to Consider Surgery
Surgery, such as DCR, is usually considered when:
- Non-surgical methods have failed to relieve symptoms.

- The obstruction is causing significant discomfort or recurrent infections.

- There is a structural issue that cannot be resolved with less invasive methods.

In conclusion, if you are experiencing persistent tearing and discharge, it is essential to follow up with your healthcare provider. They can assess the severity of your condition and recommend the most appropriate treatment options tailored to your needs. Understanding the potential procedures and their implications can help alleviate anxiety and prepare you for the next steps in managing nasolacrimal duct obstruction.

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