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What is Tear Duct Obstruction?
Tear duct obstruction, also known as a blocked tear duct, nasolacrimal obstruction, or dacryostenosis, is a condition in which the nasolacrimal passage which drain the tears from the surface of the eye become blocked.  As a result, tears are unable to drain properly and often overflow onto the face and cheek.  Tear duct obstruction may be present at birth and may occur in children and adults as well.

What causes Tear Duct Obstruction?
Many children have some degree of blockage of their tear passages at birth.  In most cases, the blockage clears as the infant develops and no further treatment is required. In older children and adults, blockage may occur as a result of an injury, infection, nasal polyps or tumor.  

What are the signs and symptoms of Tear Duct Obstruction?
The primary symptom of tear duct obstruction is excessive tearing in which tears often overflow and run down the face and cheek.   Infection can be associated with tear duct obstruction, resulting in redness and swelling of the inner corner of the eye as well as tenderness and discharge.  Blockage may occur in one eye or both simultaneously.

What are the treatments for Tear Duct Obstruction?
Treatment of blocked tear ducts depends on the age of the patient, the cause of the blockage and the symptoms.  In infants, massaging the area between the eye and the nose several times a day is usually successful in helping the blockage to resolve on its own. If the blockage continues past the child's first birthday, then a probing procedure may be performed to try to open the duct.  Rarely, if other treatment methods are not successful, a small tube may be temporarily placed in the duct to keep it open.
In older children and adults, the cause of the blockage must first be determined.  If an infection is present, then it is treated with antibiotics.  Warm compresses may also be recommended to try to clear the blockage.  If the blockage persists, then a surgical procedure is performed in which a new passage is created internally to drain the tears (Dacryocystorhinostomy).

Tear Duct Obstruction Surgery
If conservative measures are not successful, then a surgical procedure to create a new tear drain to bypass the obstruction called a dacryocystorhinostomy (DCR) may be performed. During the outpatient procedure, a small incision is made, and a new tear drain is created from the tear duct directly to the nose.  A small, temporary, silicone tube may be placed in the new tear drain to keep it open while it heals.  This procedure may be performed via and open approach or endoscopically avoiding any incisions on the face. The DCR procedure is successful in the majority of patients and is performed on an outpatient basis.

If DCS does not clear the obstruction or if injury or chronic infection has damaged the tear duct beyond repair, then an artificial tear duct called a Jones tube may be surgically implanted. The artificial duct is permanently implanted behind the inner corner of the eyelid to drain tears into the nose.  

Both DCR and implantation of the Jones tube are surgical procedures usually performed by an oculoplastic surgeon.  Dr. Ebby Elahi specializes in conditions related to the eyelids, tear ducts and orbit (area around the eye).

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