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 Blocked tear duct

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PostSubject: Blocked tear duct   Blocked tear duct EmptyTue Jan 04, 2011 9:14 pm

When you have a blocked tear duct, your tears can't drain normally, leaving you with a watery, irritated eye. Blocked tear ducts are caused by a partial or complete obstruction in the tear drainage system.

As many as 20 percent of newborn babies have a blocked tear duct at birth, but it usually clears up on its own in the first year of life. Adults can get a blocked tear duct as a result of an infection, inflammation, an injury or a tumor. A blocked tear duct almost always is correctable, but the treatment depends on the cause and your age.

Symptoms

Signs and symptoms may be caused by the blocked tear duct or from an infection that develops because of the blockage. Look for:

* Excessive tearing
* Watery eyes
* Recurrent eye inflammation (conjunctivitis)
* Recurrent eye infections (dacryocystitis)
* Painful swelling of the inside corner of the eye
* Eye mucus discharge
* Blurred vision
* Bloody tears

When to see a doctor
If your eye has been watery and leaking or is continually irritated or infected, make an appointment to see your doctor. Some blocked tear ducts are caused by tumors pressing on the tear drainage system, and quick identification of the tumor can give you more treatment options.

Causes

Most of your tears come from your lacrimal glands, which are located above each eye. The tears flow down the surface of your eye to lubricate and protect it, and then drain into tiny holes (puncta) in the corners of your upper and lower eyelids. The tears then travel through the small canals in the lids (canaliculi) to a sac where the lids are attached to the side of the nose (lacrimal sac), then down a duct (the nasolacrimal duct) before emptying into your nose, where they evaporate or are reabsorbed. A blockage can occur at any point in the tear drainage system, from the puncta to your nose. When that happens, your tears don't drain properly, giving you watery eyes and increasing your risk of eye infections and inflammation.

Blocked tear ducts can be present at birth (congenital) or can occur at any other age. Causes include:

* Congenital blockage. As many as 20 percent of all newborns have a blocked tear duct. In these instances, the tear drainage system may not be fully developed or there may be a duct abnormality. A thin tissue membrane often remains over the opening that empties into the nose (nasolacrimal duct) in congenitally blocked tear ducts. This usually opens spontaneously during the first or second month of life.
* Abnormal development of the skull and face (craniofacial abnormalities). The presence of craniofacial abnormalities, including those in certain disorders such as Down syndrome, increases the likelihood of blockage of the tear ducts.
* Age-related changes. Older adults may experience age-related changes that can cause blocked tear ducts, including narrowing of the punctal openings.
* Eye infections or inflammation. Chronic infections and inflammation of your eyes, tear drainage system or nose can cause your tear ducts to become blocked.
* Facial injuries or trauma. An injury to your face can cause bone damage near the drainage system and disrupt the normal flow of tears through the ducts.
* Tumors. Nasal, sinus or lacrimal sac tumors can occur along the tear drainage system, blocking it as they grow larger.
* Cysts or stones. Sometimes, cysts and stones form in the tear drainage system, creating blockages.
* Topical medications. Rarely, long-term use of certain topical medications, such as those that treat glaucoma, can cause a blocked tear duct.
* Other medications. A blocked tear duct is a possible side effect of docetaxel (Taxotere), a commonly used chemotherapy medication for breast or lung cancer.
Risk factors

Certain factors increase your risk of developing a blocked tear duct:

* Age and sex. Older women are at highest risk of developing blocked tear ducts due to age-related changes.
* Chronic eye inflammation. If your eyes are continually irritated, red and inflamed (conjunctivitis), you're at higher risk of developing a blocked tear duct.
* Previous surgery. Previous eye, eyelid, nasal or sinus surgery may have caused some scarring of the duct system, later resulting in a blocked tear duct.
* Glaucoma. Anti-glaucoma medications are often used topically on the eye. If you've used these or other topical eye medications, you're at higher risk of developing a blocked tear duct.
* Previous cancer treatment. If you've had radiation or chemotherapy to treat cancer, particularly if the radiation was focused on your face or head, you're at higher risk of developing a blocked tear duct.

Complications

Because your tears aren't draining the way they should, the tears that remain in the drainage system become stagnant, promoting growth of bacteria, viruses and fungi. These organisms can lead to recurrent eye infections and inflammation. Any part of the tear drainage system, including the clear membrane over your eye surface (conjunctiva), can become infected or inflamed because of a blocked tear duct.

Preparing for your appointment

You'll probably first visit your primary care physician for a blocked tear duct. However, you may then be referred to a doctor who specializes in treating disorders of the eye (ophthalmologist). In some instances, your general ophthalmologist may refer you to an ophthalmologist who specializes in ophthalmic plastic surgery.

Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to arrive prepared. Here's some information to help you get ready, and what to expect from your doctor.

What you can do

* Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help make the most of your appointment. For a blocked tear duct, some basic questions to ask include:

* What's the most likely cause of my symptoms?
* Are there other possible causes for my symptoms?
* What kinds of tests do I need? Do these tests require any special preparation?
* Is this condition temporary or long lasting?
* What treatments are available, and which do you recommend?
* What types of side effects can I expect from treatment?
* Are there any brochures or other printed material that I can take with me? What websites do you recommend?
* Is this condition related to another medical disorder?
* If I don't have anything done to correct this problem, what are the risks to my vision?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
At your appointment, your doctor will gather a history of your eye symptoms and ask questions related to the causes of blocked tear ducts, as well as other conditions that can cause watery, irritated eyes. When you go to see your doctor, he or she may ask about:

* Your symptoms, how long they've lasted and if anything relieves them
* Any previous eye or eyelid surgery
* Any previous facial trauma, injuries or surgery
* Any facial nerve conditions, such as Bell's palsy
* Any previous radiation treatment
* Any medical problems, such as diabetes or long-standing skin disorders, such as atopic dermatitis
* Any present or past contact lens use

Be prepared for an eye exam and a few tests to see how your tears are draining. Your doctor will also examine the inside of your nose to determine if any structural disorders of your nasal passages are causing an obstruction. If a blocked tear duct is suspected, other tests may be performed to find the location of the blockage in order to choose the best treatment.
Tests and diagnosis

Some of the tests used to diagnose a blocked tear duct include:

* Tear drainage test (fluorescein dye disappearance test). To test how your tears are draining, one drop of a special dye is placed in each eye. If there's a significant amount of dye in your eye after five minutes of normal blinking, you may have a blocked tear duct.
* Irrigation and probing. Your doctor may flush a saline solution through your tear drainage system to check how it's draining, or use a slender instrument (probe) inserted through the tiny drainage holes at the corner of your eye (puncta) to check for blockages. During this probing, the puncta usually dilates and if the problem is simply a narrowed puncta, this procedure may resolve the problem.
* Eye imaging tests (dacryocystography or dacryoscintigraphy). In these procedures, a contrast dye is passed from the puncta in the corner of your eye through your tear drainage system. Then, X-ray, computerized tomography (CT) or magnetic resonance imaging (MRI) images are taken to find the location and cause of the blockage.

Treatments and drugs

The cause of your blocked tear duct will determine which treatment is right for you. Sometimes, more than one treatment or procedure is needed before a blocked tear duct is completely corrected.

If an infection is suspected, your doctor will likely prescribe antibiotics.

If a tumor is causing your blocked tear duct, treatment will focus on the cause of the tumor. Surgery may be performed to remove the tumor, or your doctor may recommend using other treatments to shrink it.

Treatment options for non-tumor-blocked tear ducts vary from simple observation to surgery.

Conservative treatment
A high percentage of infants with congenital blocked tear duct improve on their own in the first several months of life, after the drainage system matures or the extra membrane involving the nasolacrimal duct opens up.

If your infant's blocked tear duct isn't opening on its own, your doctor may recommend that you use a special massage technique to help open up the membrane covering the lower opening into your baby's nose. Ask your doctor to show you how to perform this massage.

Conservative treatment may be recommended if the tear ducts become blocked from tissue swelling after facial injury. In most cases of blocked tear ducts after such facial trauma, the drainage system starts functioning again on its own a few months after the injury, and no further treatment is needed. Your doctor may recommend waiting three to six months after your injury before considering surgical intervention to open a blocked tear duct.

Minimally invasive treatment
Minimally invasive treatment options are used for infants and toddlers whose blocked tear ducts aren't opening on their own, or for adults who have a partially blocked duct or a partial narrowing of the puncta.

*

Dilation, probing and irrigation. This technique works to open congenital blocked tear ducts in most infants. The procedure can be done using general anesthesia or using a restraint in very young babies. First, the doctor enlarges the punctal openings with a special dilation instrument, and then a thin probe is inserted through the puncta and into the tear drainage system. The doctor threads the probe all the way out through the nasal opening, sometimes causing a popping noise as the probe pierces through the extra membrane. The probe is removed, and the tear drainage system is flushed with a saline solution to clear out any remaining blockage.

For adults with partially narrowed puncta, a similar procedure is done in the doctor's office. The tear ducts are flushed and irrigated while the puncta are dilated. If the problem is related solely to a partial narrowing of the punctal opening, this procedure will often provide temporary relief, at least. Antibiotics may be prescribed for any infections. If irrigation and dilation doesn't work, or if the beneficial effects of the dilation are only temporary, surgery may be necessary to open narrowed puncta. Sometimes, a small incision at the punctal opening may be all that's necessary.
* Balloon catheter dilation. This procedure opens tear drainage passages that are narrowed or blocked by scarring, inflammation and other acquired conditions. While you're under general anesthesia, a tube (catheter) with a deflated balloon on the tip is threaded through the lower nasolacrimal duct in your nose. The doctor then uses a pump to inflate and deflate the balloon a few times, sometimes moving it to different locations along the drainage system. This procedure is more effective for infants and toddlers, but also may be used in adults with partial blockage.
* Stenting or intubation. In this procedure, tiny silicone or polyurethane tubes are used to open up blockages and narrowing within the tear drainage system. The procedure, which is usually done under general anesthesia, involves having a thin tube threaded through one or both puncta in the corner of your eye, all the way through the tear drainage system and out through your nose. After the insertion, a small loop of tubing remains visible at the corner of your eye, but it's not usually bothersome. These tubes are generally left in for three to four months, and then removed. Possible complications include inflammation from the presence of the tube.

Surgery
Surgery is usually the treatment of choice for adults and older children with acquired blocked tear ducts. It's also effective in infants and toddlers with congenital blocked tear ducts, though it's typically used after other treatments have been tried.

The surgery used to treat most cases of blocked tear ducts (called dacryocystorhinostomy) reconstructs the passageway for tears to drain out through your nose normally again. First, you're given a general anesthetic, or a local anesthetic if it's performed as an outpatient procedure. The surgeon accesses your tear drainage system, and then creates a new, direct connection between your lacrimal sac and your nose. This new route bypasses the duct that empties into your nose (nasolacrimal duct), which is the most common site of blockage. Stents or intubation typically are placed in the new route while it heals, and then removed three or four months after surgery.

The steps in this procedure vary, depending on the exact location and extent of your blockage, as well as your surgeon's experience and preferences.

* External. An external dacryocystorhinostomy is a commonly used surgical method of opening a blocked tear duct. While you're under general anesthesia, your surgeon makes an incision on the side of your nose, near where the lacrimal sac is located. After connecting the lacrimal sac to your nasal cavity and placing a stent in the new passageway, the surgeon closes up the incision with a few stitches.
* Endoscopic or endonasal. The same bypass procedure can be performed using endoscopic instruments. Instead of making an incision, the surgeon uses a microscopic camera and other tiny instruments inserted through the nasal opening to your duct system. Sometimes, a fiber-optic light is inserted into your puncta to illuminate the surgical area. The benefits of this method are that there's no incision and no scar, and the recovery typically is faster and easier. The drawbacks are that it requires a surgeon with special training, and the success rates aren't as high as with the external procedure.
* Bypassing the entire lacrimal duct system. Depending on the type of blockage, your surgeon may recommend a reconstruction of your entire tear drainage system (called conjunctivodacryocystorhinostomy). Instead of creating a new channel from the lacrimal sac to your nose, the surgeon creates a new route from the inside corner of your eyes (puncta) to your nose, bypassing the tear drainage system altogether.

Following surgery for a blocked tear duct, you'll use a nasal decongestant spray as well as topical eyedrops to prevent infection and reduce postoperative inflammation. After three to six months, you'll return for removal of any stents used to keep the new channel open during the healing process.

Prevention

There's no known way to prevent a congenital blocked tear duct. To reduce your risk of developing a blocked tear duct later in life, be sure you get prompt treatment of eye inflammation or infections. Follow these tips to avoid eye infections in the first place:

* Avoid contact with children and adults who have pink eye (conjunctivitis).
* Wash your hands thoroughly and often.
* Try not to rub your eyes.
* Replace your eyeliner and mascara regularly, and never share these cosmetics with others.
* If you wear contact lenses, keep them clean according to recommendations provided by the manufacturer and your eye care specialist.
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