Disease Description (Causes and Symptoms)
- Definition: A condition in which the nasolacrimal duct (tear duct) is partially or completely blocked, preventing tears from draining into the nose (tearing, discharge, etc.).
- Causes and pathophysiology:
- Congenital: A thin membrane (punctal obstruction) often remains at the distal end of the nasolacrimal duct in newborns (approximately 5% of newborns). Most cases (80–90%) open spontaneously within 2–4 months after birth.
- Acquired (adults): Associated with chronic dacryocystitis, age-related stenosis (degenerative changes), chronic sinusitis, conjunctivitis, and other conditions. Idiopathic stenosis can also occur.
- Site of obstruction: Stenosis or obstruction at any one of the following—punctum → canaliculus → common canaliculus → lacrimal sac → nasolacrimal duct—can cause tears to stagnate and may lead to inflammation due to bacterial growth.
- Main symptoms:
- Persistent or recurrent tearing (tear pooling/overflow, epiphora)
- Mucoid or purulent discharge (eye discharge, reflux from the punctum)
- Tenderness around the lacrimal sac (during acute inflammation), redness and swelling
- Newborns: Excessive eye discharge and tearing (most improve with conservative treatment)
Treatment Methods
- Conservative/initial treatment (especially for newborns)
- Lacrimal sac (Crigler) massage: Gently press downward and inward toward the lacrimal sac (perform several times a day according to the doctor’s instructions). Do not use excessive force.
- Topical antibiotics (when the discharge is purulent) and maintaining cleanliness (cleaning around the eyes).
- Most congenital obstructions improve within 2–6 months, so observation and conservative treatment are prioritized.
- Interventional treatment
- Lacrimal duct irrigation and probing: Commonly performed in children. If initial treatment fails, repeat probing or silicone tube insertion may be considered.
- Silicone intubation: Used for recurrent obstruction or complex lesions.
- Surgical treatment (mainly for adults and recurrent/refractory cases)
- Dacryocystorhinostomy (DCR): The standard surgery that creates a bypass by directly connecting the lacrimal sac to the nasal cavity (external or endoscopic approach). Recent endoscopic DCR minimizes scarring.
- Acute dacryocystitis (including abscess): Systemic antibiotics and, if necessary, incision and drainage. DCR is not performed immediately during the acute phase (it is performed after the infection is controlled).
- Post-treatment care
- Follow instructions regarding irrigation and antibiotic use after surgery, and care for the nasal mucosa (after endoscopic surgery).
- Prognosis
- Newborns: Most recover spontaneously or are cured with simple treatment.
- Adults: The prognosis is favorable after appropriate surgery, especially DCR. If left untreated for a long time, recurrent infections, cosmetic problems, and, rarely, effects on vision may occur.
Checklist Before an Outpatient Visit (Including Preparations and Example Questions)
- Recommended items to bring
- A list of current medications (including prescription drugs, over-the-counter drugs, and supplements)
- Previous ophthalmology and otolaryngology medical records and test results (if available)
- Photos showing when symptoms began and how they have progressed (such as discharge and redness)
- A record of fever, a history of eye infections, and any recent upper respiratory infection
- Useful self-records for the outpatient visit
- Frequency and timing of tearing (whether it worsens with exercise, wind, or eye irritation)
- Characteristics of the discharge (mucoid/purulent), color, and whether it has an odor
- Presence or absence of pain, redness, or reduced vision
- Example questions (questions for the patient to prepare for the doctor)
- How can we distinguish whether this symptom is congenital or acquired?
- How long will the effect last if I undergo lacrimal duct irrigation (probing)?
General Example Questions to Ask the Doctor
- What are the side effects of this medication (or treatment)? (Such as topical antibiotics, oral antibiotics, and those related to anesthesia.)
- What is the prognosis for my symptoms? When can I expect to return to normal daily life after treatment?
- What should I be careful about in daily life (eye hygiene, massage technique, exercise, swimming, etc.)?
- What is the likelihood of recurrence, and what treatment options are available if it recurs?
Disease-Specific Example Questions
- For newborns:
- How long is it safe to wait while managing my child’s nasolacrimal duct obstruction conservatively? When do you recommend a procedure?
- For adults/surgery:
- Which method is more appropriate in my case—endoscopic DCR or external DCR—and what are the advantages and disadvantages of each?
Additional situations requiring emergency medical care (immediate hospital visit recommended): Rapid swelling around the eye, pain, high fever, or reduced vision (suspected orbital/anterior segment inflammation or orbital cellulitis).