Dacryostenosis is obstruction or stenosis of the nasolacrimal duct, causing excess tearing.

Nasolacrimal obstruction may be congenital or acquired. One cause of congenital obstruction is inadequate development of any part of the nasolacrimal ducts. Typically, a membrane at the distal end of the nasolacrimal duct persists (valve of Hasner). There is tearing and purulent discharge; the condition may manifest as chronic conjunctivitis, usually beginning after the age of 2 weeks (most often at age 3 to 12 weeks).

There are many causes of acquired nasolacrimal duct obstruction. The cause is most often age-related stenosis of the nasolacrimal duct. Other causes include past nasal or facial bone fractures and sinus surgery, which disrupt the nasolacrimal duct; inflammatory diseases (eg, sarcoidosis, granulomatosis with polyangiitis [formerly Wegener granulomatosis]); tumor (eg, maxillary and ethmoid sinus tumors); and dacryolith.

What causes a blocked tear duct?

Tears help clean and lubricate the eye and are produced in the lacrimal gland, located under the bone of the eyebrow.

Tears from the lacrimal gland flow over the eye through tiny ducts along the eyelid and drain away from the eye through two small openings at the inner corner of the eyelids.

They then drain into a larger passage from the eye to the inside of the nose, called the nasolacrimal duct, or tear duct.

In some babies, the openings into the tear duct haven’t formed properly. This causes a blockage, and the tears have no place to drain. A blocked tear duct can occur in one or both eyes.

What are the symptoms of a blocked tear duct?

Each child may experience symptoms differently, but the most common symptoms of a blocked tear duct include:

• Tears pooling in the corner of your baby's eye
• Tears draining down your baby's eyelid and cheek
• Mucus or yellowish discharge in the eye
• Reddening of the skin from rubbing

Because infants don’t produce tears until they are several weeks old, a blocked tear duct may not be noticeable at birth. A blocked tear duct may also be noticeable only when a baby cries, or in cold or windy weather when tears are stimulated.

How is a blocked tear duct diagnosed?

A blocked tear duct is usually diagnosed based on a complete medical history and a physical examination of your child. Additional tests are not usually required to confirm the diagnosis.

What are the treatment options for a blocked tear duct?

The most common treatment for a blocked tear duct is gently "milking" or massaging the tear duct two to three times a day. If there are symptoms of infection, antibiotics developed specifically for use in the eye may be used.

Fortunately, nearly all blocked tear ducts open on their own, usually by the time the child is 1 year old. If the duct still remains blocked, the duct opening can be enlarged with a small probe. The procedure may need to be repeated, but it's effective in most cases.

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The Ophthalmologist: Clinical and Therapeutic Journal
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