Blocked tear duct is a pathology accompanied by difficulty in the outflow of tears along the physiological pathway. The main manifestations of the disease are increased tearfulness, a symptom of “wet” eyes, the appearance of “fog” in front of the eyes, a feeling of discomfort in the medial corner of the eye socket, irritation of the skin of the eyelids and face. Diagnostics includes computed tomography, dacryocystography and diagnostic probing. Conservative tactics are reduced to massaging the affected area. For therapeutic purposes, probing is carried out, and if there is insufficient effect, dacryocystorinostomy with or without stenting.
General information
Blocked tear duct is a widespread pathology of early childhood. Duct obturation is diagnosed in 5% of children during the newborn period. There are no statistical data on the prevalence of the disease among adult patients. The disease occurs with the same frequency among men and women. Patients with anatomical predisposition to the development of pathology have a high probability of recurrent or complicated course. Violation of the patency of the nasolacrimal canal is diagnosed everywhere, there are no geographical features of prevalence.
Causes
The cause of impaired patency of the lacrimal tract in people with a congenital variant of the disease is hypoplasia or blocked tear duct by a mucous plug. With underdevelopment of the channel, its length and lumen are significantly less than normal. Obturation is caused by the ingress of amniotic fluid into the lumen of the tubules. The main causes of the acquired form of pathology are considered to be:
- Blockage by foreign bodies. The most common cause of obstruction is the ingress of cosmetics, dust or industrial chemicals into the tear ducts. Obturation is facilitated by the formation of dacryolites.
- Anatomical and physiological predisposition. Frequent relapses are observed in persons with abnormalities of the structure of the eyelids and facial skull. Episodes of blockage occur with Down syndrome, cleft palate or defects in the structure of the external nose.
- Infectious diseases of the eyes. With chronic conjunctivitis or rhinitis, there is a high probability of formation of adhesions in the nasolacrimal duct. Dense synechiae are an obstacle to the outflow of tear fluid.
- Traumatic injuries. Lacrimal tract injuries are a common occurrence in fractures of the nose, bone walls of the eye socket and eyeball. Injury to the nasolacrimal canal often occurs when it is probed or washed.
- Pathological neoplasms. With the formation of tumors of the nose, lacrimal sac or bone walls, there is a high risk of impaired tear outflow. Irritation of the neoplasm with tear fluid further aggravates the course of the disease.
Pathogenesis
Tears are synthesized by the lacrimal gland. After washing the anterior surface of the eyeball with tear fluid, the tear is directed to the medial corner of the eye. Through lacrimal points and tubules, it enters the common lacrimal canal and the sac, which passes into the nasolacrimal canal. The lacrimal duct opens under the lower nasal conch. With blocked tear duct, the outflow of tears is impossible. This leads to the fact that all of the above structures overflow with tear fluid. Prolonged stasis aggravates obstruction, promotes the secondary formation of concretions from inorganic substances that make up the tear (sodium chloride, sodium carbonate and magnesium, calcium).
Classification
There are one- and two-sided obstruction of the tear ducts. The disease can occur in isolation or be the result of other pathologies (dacryolithiasis, cleft palate, trisomy on chromosome 21). If it is not possible to establish the etiology of the blocked tear duct, we are talking about an idiopathic form. According to the clinical classification , the following variants of the disease are distinguished:
- Innate. With this form, the obturation of the channel occurs in its lower part. Dacryolites have a soft consistency. The disease is diagnosed in the neonatal period.
- Acquired. Overlap of the lumen of the duct is possible in any part, but most often the canal is affected in the upper parts. The consistency of the concretions is dense. Self-healing is almost impossible.
Symptoms
With congenital pathology, the first symptoms are detected even in the newborn period. Parents note involuntary tearfulness in the child. The symptom of a “wet” eye is determined. If the cause of the disorder is an embolism with amniotic fluid or obstruction by a mucosal plug, light massaging of the duct contributes to a complete regression of clinical symptoms. The general condition of the child does not suffer. Self-healing is possible during the first 2 months of life. With an anatomical defect of the structure, massaging the affected area does not eliminate the symptoms. The symptoms of the disease are aggravated by crying.
Patients with the acquired form complain of excessive tearing, photophobia, discomfort in the inner corner of the eye. Lacrimation increases in cold weather or in strong winds. The stagnation of tears is visually determined, which leads to “blurring” of vision. Over time, a burning sensation develops in the eyes and irritation of the skin of the lower eyelid, the ocular region and the nose, due to the flow of tear fluid along the medial surface of the nose and cheeks. When an infection is attached, the discharge from the eyes acquires a yellow-green color, the eyelashes can stick together. In some cases, the pathology is characterized by a recurrent course.
Complications
Most often, the disease is complicated by dacryoadenitis, dacryocystitis. Obstruction of the lacrimal pathways potentiates the formation of dacryolites, which entails the development of dacryolithiasis. Patients are at risk of inflammatory lesions of the anterior segment of the eyeball (conjunctivitis, keratitis, blepharitis). With the progression of the adhesive process, a total violation of the patency of the duct is possible. Constant irritation of the skin with tears contributes to the occurrence of eczema. Frequent performance of invasive interventions causes a decrease in the sense of smell.
Diagnostics
The diagnosis is based on a visual examination and instrumental examination. With a congenital variant of the disease, it is often not possible to identify tear points, sometimes even in the first days of life, congenital malformations of the facial skull or external nose are diagnosed. Specific diagnostic methods include:
- Computed tomography of the nasal-orbital zone. The technique allows you to study the structural features of the tear ducts. In the congenital form of the disease, the diameter of the lumen of the nasolacrimal duct is less than 1.5 mm in newborns and less than 2 mm in adults.
- Probing of the lacrimal pathways. Probing of the nasolacrimal duct can be diagnostic or therapeutic. The procedure makes it possible to determine the place of obstruction, and in some cases to eliminate the cause of the disease.
- Dacryocystography. With the help of this technique, it is possible to establish the localization of the affected area, to assume what is the cause of the disease. Defects in the passage of contrast along the nasolacrimal duct are revealed.
Treatment
Treatment tactics are determined by the form and nature of the course of the disease. With the congenital genesis of pathology, a wait-and-see tactic is shown. Infants are given a massage of the lacrimal sac and the passage of tears is monitored. If massaging promotes the outflow of tear fluid, parents are recommended to repeat this procedure daily for 2 months from the moment of birth of the child. During this time, the lacrimal pathways ripen, the symptoms are leveled. If the massage does not have the desired effect, probing is carried out from the second month of life. It is advisable to carry out manipulation up to 4-6 months (the beginning of teething).
In patients with an acquired form of the disease, treatment begins with probing and washing the nasolacrimal canal. If a threefold repetition of the procedure does not give results, dacryocystorinostomy is indicated. During surgery, an artificial communication is created between the lacrimal sac and the nasal cavity. Silicone intubation stents can be implanted to achieve the desired effect. Stenting prevents the re-formation of connective tissue junctions, the occurrence of relapses of the disease.
Prognosis and prevention
Pathology is characterized by a favorable outcome. Specific preventive measures have not been developed. Nonspecific prevention is reduced to proper care of the conjunctiva of the eyes and nasal cavity in newborns. If an obstruction of the lacrimal tract is suspected, an ophthalmologist’s consultation is indicated. A child with a history of this pathology should be registered at a dispensary. Patients should carefully monitor eye hygiene (remove makeup in a timely manner, apply only high-quality decorative cosmetics). When working in a dusty room or with chemicals, personal protective equipment (mask, glasses) should be used.
