What is it?
tear duct obstruction
It is the most common condition of this area of the eye and may be congenital (from birth) or develop during adulthood.
The lacrimal ducts consist of several anatomical parts. The lacrimal punctum, where they start, the upper and lower caniculi, also known as lacrimal ducts (they channel the tear into the lacrimal sac), the lacrimal sac, whose role is fundamental in the tear drainage system, and the nasolacrimal duct (duct that goes from the lacrimal sac to the nose).
The obstruction of the lacrimal duct is manifested by the difficulty in the elimination of tears, whose functions of protection, hydration and lubrication of the eyeball are essential in the visual system. This difficulty is due to the alteration of its natural drainage system.
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The main symptoms derived from this pathology are constant tearing (epiphora), which can be quite annoying and uncomfortable for the patient depending on the amount of tears produced and the degree of obstruction of the tear duct (partial or total), secretion (eye discharge), eye redness and even infections in the lacrimal sac(dacryocystitis).
Treatment of lacrimal duct obstruction
DIAGNOSIS
Contrast dacryocystography is a procedure that allows the study of the lacrimal duct through radiology techniques, with the objective of exploring and diagnosing complex obstructions of the lacrimal duct.
First, topical anesthesia (eye drops) is applied to the eye to be studied. After thoroughly cleaning the tear ducts with physiological saline solution, the lacrimal punctum is dilated to introduce a small cannula. Through this, the liquid contrast is introduced in order to appreciate the lacrimal ducts with maximum detail. At this point, several X-rays are taken, which will be studied by the specialist. Finally, serum is reapplied to clean the remains of contrast from the eye.
This technique makes it possible to detect the cause of the obstruction of the tear duct and to apply the most appropriate treatment, depending on the clinical condition of each patient and the location of the obstruction.
TREATMENT
Depending on the cause of the lacrimal narrowing or obstruction, one treatment or another will be applied.
Dotplasty consists of dilation and plasty of the lacrimal puncta to combat cases of progressive narrowing (stenosis) of the lacrimal puncta and tearing problems.
After identifying the obstructed lacrimal puncta, dilators are used to widen them and eliminate the obstruction. In some cases an incision or laser application will be necessary to complete this process.
The surgery, which is performed under local anesthesia, lasts about 20 minutes if both eyes are treated, and has a rapid postoperative course with little discomfort (sometimes tearing may occur). After surgery it may be necessary to administer antibiotic eye drops, as well as periodic eye examinations to verify that the stitch drains correctly.
Another alternative technique to punctumplasty to combat the narrowing of the lacrimal puncta is the placement of “Punctum plugs” (or perforated punctal plugs), implants that keep the lacrimal puncta open and thus prevent their obstruction. This procedure is performed under local anesthesia, in about 15 minutes.
In those cases in which there is ectropion of the lacrimal point (the lacrimal point is inverted and remains outwards), the “medial spindle” technique is used, which corrects it by conjunctival approach. It consists of making a diamond-shaped cut of conjunctival tissue and suturing it to produce a correction of the eyelid malposition. It is performed under local anesthesia, in about 30 minutes. It has a postoperative course with little local discomfort. This procedure is usually complemented with a lateral tarsal strip surgery to achieve optimal results.
Lacrimal duct obstruction in newborns resolves spontaneously in most cases before the first year of life, following a treatment consisting of massaging the lacrimal sac area and maintaining good ocular hygiene. If there is an infection, antibiotics can be administered as a complementary treatment, as long as the ophthalmologist assesses it. After this time, if lacrimation persists, it is recommended to perform a lacrimal duct probing.
This surgical procedure consists of unblocking the tear duct by means of a thin metallic probe, which allows the correct drainage of tears.
It is an outpatient surgery, but in the case of children it is usually performed under general anesthesia. After this intervention, it will be necessary to occlude the eye for one day and to apply anti-inflammatory eye drops, as well as to attend the postoperative visits determined by the specialist. Surgery is reserved for the most severe cases, preferably not before two or three years of age.
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