The tear fluid that moistens the eye advances through small channels inside the eye towards the nose. The disease typically occurs due to obstruction of this canal, most commonly at the lower part of the lacrimal sac.
Tear duct obstruction most frequently appears in infants during their first year, women in middle age and beyond, individuals with a deviated nasal structure, and as a result of prolonged nasal infections and allergies. Since tears cannot pass to the nose, they flow from the eyelid to the cheek. Tear duct obstruction also frequently causes infections in the eye.
Symptoms of Tear Duct Obstruction
- Excessive tearing,
- Frequent crusting in the eye
- Inflammation of the eye with pressure on the bridge of the nose
- Swelling at the root of the nose.
Treatment of Tear Duct Obstruction in Infants
Massage is applied initially for 1 year. The massage is applied by pressing on the lacrimal sac at the root of the nose. This massage should be done 3-4 times a day for 5 minutes. There is approximately a 95% chance of the canal opening spontaneously with massage. If infections are frequent in children, probing should be performed from the sixth month onward without delay.
Antibiotic eye drops are used as necessary when crusting occurs in the eye. If tearing persists at the end of the first year, it means the canal has not opened spontaneously. Then, a probing procedure is performed. If the tearing complaint does not resolve after the first probing, silicone tube intubation is done. The tube is removed in outpatient clinics after remaining in place for 2 months. If treatment is delayed in children, the success rate decreases. If tearing does not resolve with probing, surgery called "dacryocystorhinostomy" is performed when the child reaches 3 years old.
Treatment of Tear Duct Obstruction in Adults
Dacryocystorhinostomy (Open Surgery = DSR)
An incision of approximately 1 cm is made at the root of the nose under local or general anesthesia. A small bone window is created in the nasal bone, and a direct passage from the lacrimal sac to the nasal cavity is formed. In some cases, a silicone tube may be passed through the puncta. The incision in the skin is closed with stitches, concluding the procedure. The gold standard canal surgery worldwide is the DSR surgery. If performed correctly, there is no scarring on the skin.
Potential Complications of Dacryocystorhinostomy Surgery
- Infection of the wound site
- Re-obstruction of the canal (120%)
Treatment
- Anesthesia: local or general anesthesia,
- Duration: 45 minutes
- Bandage: A fine band is placed on the incision site.
- Post-surgery: There may be swelling around the eye.
- Stitches: Removed after 7 days.
- Follow-up visits: The day after surgery, after 7 days, after 1 month, after 3 months
- Eye drops and ointment: Antibiotic ointment on the stitches for 1 week, antibiotic drops for the eyes.
How is Tear Duct Obstruction Diagnosed?
Pressure on the bridge of the nose resulting in inflammation of the eye is an important indicator of an infected canal. In this case, as the lacrimal sac is full, the pressure causes the content and inflammation to flow outward. In some cases, a palpable swelling at the root of the nose can also occur.
Frequently Asked Questions
Can tear duct obstruction resolve on its own?
Although there is a high chance of resolving tear duct obstruction in infants with massage within the first year, in adults it typically does not resolve on its own and surgical intervention may be necessary.
Can tear duct obstruction recur?
Yes, tear duct obstruction may recur. If appropriate treatment is not given and infections recur, the canal may become obstructed again. Therefore, the process should be monitored by a specialist doctor.
Does tear duct obstruction lead to blindness?
Tear duct obstruction does not directly cause blindness; however, frequent infections may cause permanent damage to the eye.
What is the recovery process like after tear duct obstruction surgery?
The recovery process after DSR surgery is rapid and comfortable. Swelling and bruising usually decrease within a few days. Stitches are removed after 7 days, and the success rate increases with regular follow-up and medication use.