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What Is Lacrimal Drainage Obstruction?

Lacrimal drainage obstruction is a blockage or narrowing anywhere along the tear outflow pathway, from the puncta to the nasolacrimal duct opening in the nose. Tears cannot drain normally, so they build up on the ocular surface and spill over the lid margin. Patients often notice constant tearing, mucus, or recurrent infections. Obstruction can be partial or complete and may affect one or both eyes. Causes range from congenital anomalies and inflammation to trauma, surgery, or tumor.

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What Is Lacrimal Drainage Obstruction?

Lacrimal drainage obstruction is a blockage or narrowing anywhere along the tear outflow pathway, from the puncta to the nasolacrimal duct opening in the nose. Tears cannot drain normally, so they build up on the ocular surface and spill over the lid margin. Patients often notice constant tearing, mucus, or recurrent infections. Obstruction can be partial or complete and may affect one or both eyes. Causes range from congenital anomalies and inflammation to trauma, surgery, or tumor.

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Causes and Types of Lacrimal Drainage Obstruction

Obstruction can occur at the puncta, canaliculi, lacrimal sac, or nasolacrimal duct. Common causes include involutional stenosis with age, chronic infection such as dacryocystitis, and scarring from trauma or surgery. Cicatrizing conjunctival diseases, radiation, or intranasal pathology can also affect the system. In infants, a congenital membrane at the nasal end of the duct is frequent. Tumors of the sac or surrounding bone are less common but important causes.

Symptoms and Clinical Features

The hallmark symptom is epiphora, or chronic tearing that runs down the cheek. Patients may also report discharge, crusting at the inner corner, or recurrent conjunctivitis. On examination, the puncta might look narrowed or normal, but pressure over the lacrimal sac can reflux mucus or pus through the punctum. Skin around the medial canthus can be irritated from constant wetness. In acute dacryocystitis, there is painful swelling and redness over the sac in addition to tearing.

How Is Lacrimal Drainage Obstruction Diagnosed?

Diagnosis combines history with targeted testing of the lacrimal pathway. The eye doctor inspects punctal size and position and performs irrigation through the puncta to see whether fluid passes into the nose or regurgitates. Probing can localize the site of blockage within the canaliculi or duct. Dacryocystography or dacryoscintigraphy gives imaging of anatomy and function when surgery is planned. Nasal endoscopy may be used to evaluate the intranasal opening and rule out masses or structural anomalies.

How Is Lacrimal Drainage Obstruction Managed?

Treatment depends on the level and cause of obstruction. Mild punctal stenosis might respond to dilation or punctoplasty. Chronic nasolacrimal duct obstruction often requires dacryocystorhinostomy to create a new drainage route into the nose, sometimes with silicone tube intubation. Congenital obstruction in infants is first managed with massage and observation, with probing if tearing persists. Active infections are treated with antibiotics before or along with surgery. Long term follow up monitors tear drainage and infection risk.

FAQs About Lacrimal Drainage Obstruction

Why do my eyes keep watering even though they do not feel dry?

When the drainage pathway is blocked, normal tear production cannot exit through the nose and instead spills over the eyelid, causing constant tearing despite adequate tear volume.

Can eye drops fix a blocked tear duct?

Drops can calm irritation or infection, but structural blockage usually needs procedures such as probing, dilation, or surgery to restore flow.

Will my baby's blocked tear duct clear on its own?

Many infants with simple congenital nasolacrimal duct obstruction improve in the first year. If tearing and discharge persist, the ophthalmologist may recommend probing.

Is surgery for lacrimal drainage obstruction done under general anesthesia?

Dacryocystorhinostomy is often performed under general or monitored anesthesia care, depending on age and health. Your surgeon will explain the approach and recovery plan.