Blocked Tear Duct Treatment Turkey

What is Tear Fluid and Does It Affect Vision?

Tear fluid is a thin layer of liquid that covers the surface of the eye. In addition to its roles in protecting the eye, distributing essential components for eye health, and providing comfort to the ocular surface, it plays a very important role in our vision. Any decrease or increase in tear production can prevent clear and high-quality vision.

The tear film consists of three main components, all of which need to be balanced: oil, water, and mucin. Any deficiency in these layers can cause tear film instability and irregularities on the ocular surface.

Tear production is carried out by primary and accessory glands located in the eyelids and on the surface of the eye, while its distribution over the eye surface is ensured by the movement of the eyelids and eyelashes. A stable tear level is maintained by a delicate balance between production, evaporation, surface distribution, and drainage. When this balance is disrupted at any stage, conditions such as dry eye or excessive tearing may occur.

Structural or shape abnormalities that disrupt tear distribution in the eyelids and obstructions in the tear drainage system can lead to excessive tearing, which significantly affects a person’s visual quality.

What is the Tear Duct?

Tear fluid is continuously produced and must also be continuously removed from the eye surface to prevent accumulation and excessive tearing.

To remove excess tears from the eye, a highly efficient drainage system exists. The most important part of this system is the tear duct. It begins at small openings called puncta located at the corners of the upper and lower eyelids near the nose, continues through short horizontal tubes called canaliculi, which join to form the lacrimal sac, and at the end of the sac, the tear duct begins.

The tear duct runs within the nasal bone and ends with a one-way valve system. In this way, tear fluid from the eye surface is drained into the nose and from there into the throat. The sensation of wetness in the throat when we cry or when our eyes water excessively is the result of this continuously operating system.

What is Tear Duct Obstruction?

Blockages can occur at any level of the tear drainage system described above. The most common site of obstruction is along the tear duct that starts after the lacrimal sac and runs within the nasal bone. For this reason, blockages in the drainage system are commonly referred to as tear duct obstructions.

When this narrow bony canal is mechanically blocked—due to stones, masses forming in the lacrimal sac, adhesions inside the sac from certain diseases, or adhesions at the canaliculus openings—tear drainage into the nose cannot occur. The accumulated tears flow backward into the eye, causing excessive tearing.

Obstructions along the tear duct after the lacrimal sac can also lead to infections. Microorganisms and their debris accumulate excessively in the sac, leading to infections, which manifest as both excessive tearing and discharge.

What Causes Tear Duct Blockage?

Tear duct blockage in adults, tear duct blockage is mostly observed at the exit level of the duct, i.e., along the bony canal that opens into the nose, and there is usually no underlying significant additional disease. It is most commonly seen in women over the age of 60, but it can occur in individuals of any age and gender.

In some patients, chronic – meaning long-lasting – microbial or non-microbial inflammations in the area between the eye and nose, long-term allergic swellings, or certain congenital or acquired anatomical anomalies in the structure of the nose can cause blockages in the system.

Nasal surgeries involving the area close to the opening of the canal or severe trauma to the eye-nose region can damage the canal system and lead to permanent blockages. Rarely, masses originating from the tear sac or from surrounding tissues that extend into this system, or external formations pressing on the system, can cause blockages. In susceptible individuals, tear stones can also develop within the tear sac and cause partial or complete blockage at the sac-duct junction.

Blockages at higher levels can occur due to prolonged exposure of the mucous membrane in the puncto-canalicular system to chemicals that damage the mucosa, such as bleach or chlorine, or due to the effects of certain viral infections that constantly inflame the mucosa. Additionally, structural abnormalities/diseases of the oil glands in the eyelid can damage the mucosa over time, leading to blockages at the entry points of the drainage system.

Prolonged use of certain eye drops (especially eye pressure drops, drops containing preservatives),some cancer medications, and radioactive iodine treatments can damage the mucosa in the entry system, leading to adhesions. Therefore, regular examination of the canal system is important for patients undergoing these treatments.

What Are the Symptoms of Tear Duct Blockage?

Regardless of the level of blockage, the most common and prominent sign of tear duct blockage is excessive tearing. The tearing that occurs in the case of a blockage is continuous, not intermittent. Due to excessive tearing, the quality of vision is significantly impaired. The salty components in the flowing tears can irritate the eyelid, the surface of the eye, and the skin, leading to a burning sensation, redness in the eye, and thinning and abrasion of the skin.

Blockages at the lower level of the tear sac will lead to infections due to excessive microbial accumulation within the sac, ranging from mild to severe. In these cases, continuous yellow-green crusting on the surface of the eye, redness in the eyes, and swelling of the eyelids will be observed. As the accumulation within the sac increases, soft swelling that drains into the eye when pressed will form between the eye and nose, and if this progresses, it will turn into painful, hard masses. If the infection advances and spreads to the skin, it can lead to severe and dangerous infections that require emergency treatment with intravenous antibiotics.

Constantly wiping tears with a tissue or rubbing the eyelids by hand can loosen the eyelid tissues, leading to structural and functional eyelid problems. Drooping eyelids can not only cause further increase in tearing but, if permanent, will require additional eyelid surgery to correct these issues.

How to Understand if the Tear Duct is Blocked?

The diagnosis of tear duct blockage is made through a clinical examination. A detailed history is first taken, followed by an eye examination and an oculoplastic evaluation. Eye surface and eyelid diseases, as well as the presence of possible foreign bodies, are ruled out through biomicroscopic examination.

The entrance of the tear duct system is examined using a biomicroscope, and then the most important step in diagnosis is the lavage procedure with a cannula. In this procedure, after the punctum (the duct entrance) is widened, a blunt-tipped cannula is inserted at the system entrance, and a sterile fluid is introduced into the nasolacrimal system.

The level of blockage in the tear duct system can be thoroughly evaluated by experienced ophthalmologists/oculoplastic surgeons through this test. If fluid passes into the throat during the test, the canal is not blocked. The lavage procedure is a diagnostic test and is not a treatment method to open the canal!

In infants, the diagnosis is typically made with a history of congenital watering-crusting, along with the presence of pus that drains when pressure is applied to the sac during the examination. In necessary cases, the fluorescein dye disappearance test, which is applied to both eye surfaces, can support the diagnosis.

In the diagnosis of tear duct blockage, additional tests and imaging methods are very rarely required. These include the dacryocystography technique, where a contrast agent is injected into the canal system with a cannula, and the region is X-rayed or a tomography is performed. There is also the dacryosintigrafy technique, where radioactive drops are applied to the eye surface and the region’s scintigraphy is taken. Additionally, especially in cases of watering due to nasal surgery or trauma, or when there is a suspicion of a tumor, a computed tomography (CT) scan or magnetic resonance (MR) imaging may be required.

Dye disappearance test in tear duct blockage. After applying fluorescein orange dye to both eyes, two minutes later, in the normal left eye, the dye on the eye surface has passed through the open system into the nose and disappeared. On the right side, however, due to the blockage in the system, the dye has not drained into the nose and is still accumulating and waiting on the eye surface.

Nasolacrimal lavage procedure used in the diagnosis of tear duct blockage.

Tear Duct Obstruction in Adults

Tear duct obstruction in adults leads to excessive tearing and crusting. While obstruction can occur in any part of the tear drainage system that drains tears into the nasal cavity, in adults, the most common obstruction is in the bone canal itself or at its terminal end. This condition is most commonly observed in women over the age of 60 and occurs without any underlying disease. Sometimes, abnormalities in the nasal cavity, trauma, severe eye infections, allergy attacks, stones or tumors within the sac, chronic drop use (especially for eye pressure),certain chemotherapy drugs, and regional radiotherapy can cause obstruction in the tear duct system.

In adults with tear duct obstruction, typically additional symptoms include a red and uncomfortable eye, recurring infections, a painful swelling at the inner corner of the eye, intense crusting, discharge, and blurred vision.

If you experience persistent tearing and discharge for several days, you should definitely consult an ophthalmologist with oculoplastic surgery training. Although rare, a tumor can press on the tear drainage system and cause duct obstruction. In this case, early diagnosis can provide the opportunity for early treatment.

During the examination, your doctor will ask questions to clarify the cause of the obstruction and, after examining the surface of the eye and the inside of the nose, will proceed with diagnostic tests for tear duct obstruction. These tests include the “dye disappearance test,” which evaluates the time it takes for the fluorescent orange dye applied to the eye surface to disappear, and the “nasolacrimal lavage” procedure, in which a fine hollow cannula is inserted into the tiny openings at the corner of the eye, and fluid is passed into the tear duct system to assess whether the fluid passes into the nose or not; if not, the level at which it regresses is evaluated. These are the most valuable diagnostic tests. These tests not only confirm the diagnosis of tear duct obstruction but also provide very informative details regarding the required type of surgery.

Blocked Tear Duct Treatment in Turkey

The only treatment for tear duct obstruction in adults is surgery. Based on the assessment of the level of obstruction, the method of surgery is determined. The obstruction is often at the section opening into the nose, and in this case, dacryocystorhinostomy surgeries are performed to create a new canal opening into the nose from the healthy part of the system. These surgeries can be done through aesthetic incisions of 7-8 millimeters on the skin, with the help of endoscopy from inside the nose, or by entering through the small openings at the corner of the eyelids with a thin laser probe.

Blocked Tear Duct Surgery in Turkey

Tear duct obstruction surgeries (dacryocystorhinostomy) are most effectively performed under local or general anesthesia, through a skin incision or with the help of an endoscope from inside the nose. The appropriate method for you will be determined during the examination.

Generally, all patients are suitable for surgery through the skin, but if the patient is not suitable for endoscopic surgery, the success rate may be lower. The advantage of skin surgery is that it allows full visualization of the sac, and intervention can be performed on tumors or higher-level obstructions if necessary. Special methods can be used to avoid leaving a scar on the skin. In this method, a very short skin incision is made between the eye and nose, the bone is reached, and a small bone window is created just behind the tear sac. The damaged part of the sac is removed, a new canal pathway is created, and to prevent the system from becoming blocked again, the sac and nasal mucosa are anastomosed in a way that covers the top of the newly created system.

The success rate of this method is reported to be between 96-99.8%, meaning the failure or recurrence rate is very low. In the endoscopic method, a new opening is created adjacent to the bony canal by entering through the nose with cameras. The success rate has been reported to be between 80-95%.

In both methods, the surgery takes about half an hour, and the patient is discharged on the same day after 2-3 hours of observation. During these surgeries, a silicone tube may be placed simultaneously to increase the success rate. This silicone tube can be easily removed from the system during an office visit 1-2 months later.

As a surgical technique, laser surgery was widely used, especially in our country for a period. However, due to the high rate of recurrence (over 50%),side effects, and the risk of causing irreversible blockages by causing burns at the system's entrance, many centers eventually abandoned this method.

The most significant reason for the failure of this method is the extreme adhesion and coagulation tendencies at the site of the created canal due to the burning of soft tissue, bone, and mucosa with very high heat. Although the name "laser treatment" sounds appealing and is technically simple to apply, it has never been recommended or applied by us, and it is now rarely used in our country.

In the open technique via skin incision, the surgery can be performed through an aesthetic incision of approximately 8 millimeters, made either through a skin fold or parallel to it. When done this way, the likelihood of scarring is negligible. The surgeon then reaches the tear sac inside the bony socket, passes through the anatomical structures without cutting muscle tissue, and carefully creates a small window in the bone behind the sac. After opening the sac, the inside is thoroughly examined, and if necessary, tissue is taken for pathological analysis.

After the nasal mucosa is opened, a tube can be inserted into the system if desired. At this stage, the surgeon may perform additional procedures to improve healing based on their experience, further increasing the chance of success. Then, the nasal mucosa and the sac edges are sutured together in a way that covers the top of the newly created channel, preventing it from becoming blocked. After suturing the muscle tissue and skin, the surgery is completed, and the patient is discharged after 1-2 hours of observation.

After Tear Duct Obstruction Surgery

Apart from the use of drops and ointments at home, no special care is required; however, forcefully blowing your nose is prohibited for about 2 weeks. A follow-up appointment is scheduled one week later to remove skin sutures. During this examination, a lavage is performed to check the patency of the system, and any tissue debris or accumulations are washed out. The inside of the nose is examined with the help of endoscopy, and if necessary, cleaning is performed to further increase the chance of success. These procedures are repeated periodically throughout the recovery period. If a tube was placed during surgery, it will be removed with a simple and painless procedure during an office visit 1-2 months later. This surgical technique has a very high success rate, and the chances of failure are very rare if done correctly.

For obstructions in the upper levels of the tear drainage system (punctum, canaliculus),the surgical procedure is a bit more detailed. These obstructions may have a higher chance of recurrence. The reason for this is the tendency for the tiny/narrow structures (canaliculus) at the upper end to re-adhere after being surgically opened. If there is a sufficiently long and slightly expandable structure in the canaliculus, opening and expanding them and placing a tube into the entrance system can sometimes be successful.

Special techniques developed by us to increase success have provided successful results in selected suitable patients, but these techniques cannot be applied to every patient. Suitable patients are identified through detailed examination.

In cases of long-term discomfort with severe inflammation (infectious or non-infectious inflammation),the placement of a silicone tube into the system, along with the use of drops, is critical in preventing the obstruction from becoming permanent and irreparable. Various types of tubes have been developed for this method, and they can be applied even in an office setting, providing the opportunity for early diagnosis and treatment to prevent serious duct obstructions.

In cases where the entrance part of the system is completely and severely adhered and cannot be opened anymore, surgical methods involving the insertion of a permanent glass tube (Jones tube) between the eye and nose are available. In classical open surgery through skin incision, many complications have been reported, and the success rate is relatively low. Compared to this technique, the closed method takes much less time and has fewer complications. The negative aspects of the old method have been addressed in the closed technique.

You can find more detailed information on this topic and the method we developed in the book chapter I wrote in 2015:

Cetinkaya A, Devoto MH. Minimally Invasive Conjunctivodacryocystorhinostomy. Chapter 16, pp163-170. In: The Lacrimal System. Diagnosis, management and Surgery, eds Cohen EJ, Mercandetti M, Brazzo B, 2nd Edition, Springer, Switzerland, 2015.

In Jones tube applications, even in the best-performed surgeries, some negative outcomes may arise in the long term. Almost all of these negative outcomes can be corrected, but the key is that the initial surgery must be performed by a highly experienced surgeon, and the patient must fully comply with the doctor's recommendations and follow-up during the post-surgical process. The simple solution techniques we have developed for problems that may arise during the Jones tube process were shared with our colleagues at the ASOPRS Congress in the United States in 2016:

Cetinkaya A. Simple Solutions to Jones Tube Complications. ASOPRS 2016, October 13-14, Chicago, IL, USA.

Permanent glass tube (Jones tube) placed in the left eye.

In patients where the Jones tube application is not suitable or those who do not want this application, another method we use is injecting botulinum toxin into the tear-producing gland to reduce the amount of tear production and thus prevent excessive tearing. This method provides relief for about 6 months, and an injection needs to be applied approximately twice a year. Although this painless and fast method cannot open the canal obstruction, it offers a practical, non-surgical solution by reducing the complaints.

Botulinum toxin injection into the left lacrimal gland to reduce tear secretion.

Tear Duct Obstruction in Infants

In cases of excessive tearing and eye discharge in infants, conditions such as foreign body, inward turning of eyelids, or eyelash irritation are first investigated. Once these diagnoses are ruled out, the most common underlying cause is tear duct obstruction. This condition typically presents within the first month after birth and is caused by membrane adhesions at the very tip of the duct. More detailed information can be found under the title “Tear Duct Obstruction in Infants.”

Obstructions that occur later on may be caused by masses that grow within the sac-duct system or develop from surrounding tissues, pressing on the system, diseases of the nasal cavity, trauma, or severe infections. Therefore, a detailed history should be taken, and the baby should be evaluated by an ophthalmologist or oculoplastic surgeon when tear duct obstruction is suspected.

Tearing that mimics duct obstruction in infants can also be caused by many other factors. In cases of sudden onset tearing in one eye, the possibility of a foreign body should be considered, and the eye should be examined thoroughly. In situations where both eyes show itching, redness, and excessive rubbing, allergy should be investigated. Inward turning of eyelashes or eyelid edge conditions are other causes of excessive tearing. A detailed eye exam with a biomicroscope can help clarify these conditions.

Tear Duct Obstruction in Newborns

Tear duct obstruction is seen in 10-15% of newborns, and the vast majority resolve within the first year. Excessive tearing can also be seen in certain eye disorders, such as congenital glaucoma, so a detailed eye examination is essential before directly diagnosing tear duct obstruction in infants with tearing.

The anatomical region that is the source of congenital tear duct obstruction is usually the part of the system that opens to the nose. The underlying causes, in order of frequency, are as follows: failure of the one-way valve at the very tip of the duct to open, adhesions/membranes at this area, developmental narrowing/obstruction of the bony framework of the duct, or rarely, complete lack of development of this bony duct. The obstruction type where the valve at the duct exit remains stuck and does not open is more frequently seen in cesarean deliveries. Congenital tear duct obstruction in newborns is typically unilateral. Rarely, conditions such as congenital agenesis of the duct openings (punctal agenesis),canalicular stenosis, improper opening of the canaliculi, or small and non-functional sacs may also be observed.

When both the upper and lower parts of the sac are blocked in a newborn, amniotic fluid may become trapped within the tear sac, leading to a bluish mass between the eye and nose known as a dacryocystocele or amniotoscele, which typically enlarges over time. This condition can turn into a severe infection or cause respiratory failure if the cystic structure grows into the nasal cavity, and thus, a highly experienced oculoplastic surgeon should be consulted without delay.

In cases of tear duct obstruction in newborns, excessive tearing and discharge will be observed during the first month after birth. Depending on the severity of the infection, redness in the eyes, swelling in the eyelids, and irritation of the eyelid skin may occur. In cases of severe inflammation of the sac, a red, hard, and painful swelling visible externally in the tear sac area may be observed, and this condition, known as dacryocystitis, requires urgent intravenous antibiotic treatment.

In infants with tear duct obstruction, symptoms will be aggravated during upper respiratory infections, in cold and windy weather, and in allergic conditions that cause swelling inside the nose. Additional treatments may be required depending on the situation.

In cases of tear duct obstruction in newborns, an ophthalmologist who has received oculoplastic surgical training will first assess all other eye conditions, and after diagnosing the tear duct obstruction with appropriate exams and tests, they will teach you the correct massage and sac cleaning techniques. They will assist you in managing the condition with temporary antibiotic drops and eyelid hygiene techniques when necessary, and if needed, they will proceed with surgical treatment to resolve the issue.

Ocular discharge or crusting following nasolacrimal duct obstruction in infants

How is Tear Duct Obstruction Treated in Babies and Newborns?

If tear duct obstruction is detected during the examination, your doctor will show you how to perform a massage to open the canal by applying pressure from the corner of the nose towards the canal, aiming to open the canal opening. In case of necessary circumstances, antibiotic drops will also be recommended. Often, incorrect massages are done by rubbing the area of the nose or the part of the eyelid unrelated to the sac, which provides no benefit. Therefore, it is important that the doctor personally shows the person who will perform the massage on the baby. Antibiotic drops are not used to open the tear duct but to prevent severe infections; no drops or ointments have the ability to open the canal.

Approximately 90% of canal obstructions resolve without the need for surgical intervention within the first 1-1.5 years. Therefore, if there is no severe infection and the discharge does not cause damage to the eyelid, early intervention is not necessary. In cases of late interventions, the chance of success in surgery has been reported to decrease, which is why it is considered appropriate to perform the first procedure around the age of 1-1.5 years.

The first step in surgical treatment is the ‘probing’ process. In this procedure, the canal opening (punctum) at the corner of the eyelid is enlarged, and a thin, blunt-tipped probe is inserted through to the sac. It is then redirected to enter the canal, where the membrane/obstruction at the canal opening is opened, and the probe exits into the nasal cavity. This procedure, performed under general anesthesia and lasting only briefly, involves no incision or stitches, and pain or discomfort is not expected after the surgery. The success rate has been reported between 90-98%, depending on the age at which it is performed. There may be some continued watering post-procedure, but it is expected to improve within a week; if watering persists after 2-3 months, the same procedure may be repeated or intubation may be considered.

In cases where the patient is older than 2-2.5 years or where probing has been ineffective, a silicone tube is placed inside the canal system in addition to probing. This process is called ‘intubation.’ These tubes remain in place for about 2-3 months after the surgery and are then removed. The tubes are not visible and cannot be felt by the patient, and they do not cause any harm to the eye. In the past, tubes that passed through both eyelids and connected in the nose were used, requiring anesthesia again to remove them after surgery. In the past 10-15 years, however, tubes passing through a single eyelid have been used and can be removed in seconds without requiring anesthesia once the procedure is complete. When the patient is over 5 years old, the success rates of probing or tube placement significantly decrease. In such cases, adult-type canal surgeries, in which a new channel is created through a small incision or inside the nose, are necessary.

All three of the aforementioned methods, when applied within the appropriate age range, have a very high success rate in treating tear duct obstructions.

Misconceptions About Tear Duct Obstruction Surgery Unfortunately

There are many misconceptions and incorrect medical information that mislead and scare patients about this surgery. Some of the false claims include breaking the nasal bone, the surgery being extremely painful and bloody, a high failure rate, and the system becoming blocked again even if it works initially. These incorrect statements can lead patients to avoid this surgery and live for years with tears and pus continuously flowing from their eyes.

These surgeries can be performed under general anesthesia or sedation, and the patient will not feel any pain or discomfort during the surgery. There is no bleeding during the procedure when it is performed with the correct techniques and simple precautions. There is no risk of breaking the nasal bone; a small window is made in the bone behind the sac, which is not visible from the outside, and a new channel is created inside this bone. This process is done gently, and there is no breaking or fracturing involved. The success rate of the surgery is very high when performed by experienced surgeons, and the chances of recurrence are very low.

As observed during corrective surgeries for numerous patients who have failed surgeries at other centers, in many of these patients, the small window in the bone through which the new canal should pass had never been opened, or it had been opened in the wrong area, or the window opened was too small and non-functional. In a few cases, even when the surgery had been done properly, the new canal had become obstructed with healing tissue during the recovery process because necessary precautions had not been taken.

With correct anatomical and surgical principles, success can be achieved in all corrective surgeries. In summary, for patients whose previous surgeries have failed, the surgical procedure can be repeated, and success can be achieved.

Tear Duct Obstruction Silicone Tube Placement In

Cases where probing fails in babies or where it is too late for probing due to the baby’s age, a silicone tube needs to be placed in the tear duct system. In this procedure, a silicone tube is advanced from the tear duct opening on the lower eyelid through the canaliculus (from the punctum to the canaliculus) and is directed towards the sac with a maneuver that requires experience. From there, it pushes through the adhesions in the bony canal and moves towards the nose.

In this procedure, the existing canal system is used; no incision is made in the skin or other tissues, and no new canal is opened. Today, stents, or silicone tubes, which are preloaded with equipment, can be easily placed into the system, and the mechanism of the carrier system releases the tube and retracts once the tube is in place, completing the procedure. The tubes are removed after being in place for 1-6 months, as deemed appropriate by the doctor, in an office setting with a quick, painless procedure that does not require anesthesia. The same applies to new tube systems that pass as a single piece through the upper and lower parts and do not require a knot inside the nose.

Lacrijet silicone tube placement in the right upper eyelid with a tear system ready cartridge.

In adult tear duct obstructions, if the structures at the entrance of the system are affected and complete blockage has not developed at the opening to the nose, placing a silicone tube in the system is necessary to prevent complete closure of the entrance by adhesions. This procedure involves no incisions, scarring, or sutures.

There are many tube alternatives available depending on the needs of the patient. Short tubes that can be placed only at the entrance of the lower eyelid, short tubes that are placed in a circular manner up to a certain distance in both eyelids, or single-channel or double-channel tubes that pass through the entire system can be selected according to the needs based on the examination results.

Most procedures can be performed in an office setting without anesthesia. In more detailed cases or when anesthesia is required, the procedure can also be performed under local anesthesia, sedation, or general anesthesia in the operating room.

After this procedure, no special care is required, and short-term eye drops are used. Patients can return to their daily life without any disruption. The tubes can remain in the system for an extended period without causing any discomfort, and after the period deemed appropriate by the doctor, they can be removed in the office setting with a quick, painless procedure.

The position of the tube in the system and the patency of the system being confirmed with the dye disappearance test after intubation with a silicone tube placed in the upper and lower eyelids of the right eye.

Lacrimal Duct Obstruction Laser Treatment

As discussed in detail under the title 'Lacrimal duct obstruction surgery,' the technique with the highest failure rate and potential to cause many new, permanent problems is the laser lacrimal duct surgery technique. This technique, which is not preferred in developed countries, has also gradually been abandoned in our country.

Can Lacrimal Duct Obstruction Be Treated Without Surgery?

In lacrimal duct obstruction, there is no possibility of non-surgical treatment in adults. Since the bone channels in the body do not have the flexibility to expand or stretch like in infants, spontaneous opening is not possible. Methods such as probing and laser use have been tried for years to open the inner parts of these structures, but because the smooth surface inside the duct is compromised, systems become blocked again due to adhesions shortly after. Therefore, when the duct system is blocked in adults, there is no method other than surgical treatment that involves opening a new duct system; non-surgical treatment is not possible.

How is Lacrimal Duct Obstruction Opened?

In infants, lacrimal duct obstruction is treated with probing, tube placement, or surgical creation of a new duct if necessary. In adults, lacrimal duct obstruction can only be opened with surgery to create a new duct path. Detailed information about these techniques can be found under the 'treatment' headings.

In cases where lacrimal duct obstruction is not 100%, where the narrowing has not completely closed, or when the system is blocked with lacrimal stones, a 'naso-lacrimal lavage' procedure (a procedure where liquid is introduced into the system with a catheter to diagnose duct obstruction) can help clean the accumulation in the narrowed area, allowing partial flow and reducing discharge and watering. This procedure can delay the complete obstruction. Cleaning the system in this way and removing the accumulations and debris from the sac and duct can provide a healthier environment, making it a useful application in cases of partial obstruction.

Does Lacrimal Duct Obstruction Resolve on Its Own?

In newborns, lacrimal duct obstruction may resolve on its own, and it is even highly likely. However, this is not the case in adults, and the only effective treatment for complete duct obstruction is surgery.

What Happens if Lacrimal Duct Obstruction Is Not Treated?

If lacrimal duct obstruction is not treated, the eyes and eyelids will remain constantly swollen and red; the skin of the eyelids will be irritated by discharge and the salts in the tears. The accumulated discharge and excess tears will hinder the patient's ability to see clearly, causing them to constantly wipe their eyes to improve their vision.

Constant wiping of the watery eye with hands or tissues can lead to stretching and loosening of the eyelids, resulting in sagging that requires surgery. This, in turn, makes it even more difficult for tears to enter the duct, leading to a significant increase in tearing.

Bacteria can multiply in the lacrimal sac, which serves as a protective, sheltered environment, inaccessible to the body’s defense mechanisms, and may cause increasing amounts of discharge and even serious sac infections. If these sac infections spread beneath the skin, they can turn into more severe infections that require intravenous antibiotics for treatment.

If these infections are not treated or contain rapidly multiplying harmful bacteria, they may spread to the orbit (eye socket),causing visual disturbances, double vision, and even lead to orbital cellulitis, which can pressure the optic nerve and threaten vision. If left untreated, the infection can spread to the brain, leading to life-threatening brain infections and abscesses.

Acute dacryocystitis resulting from untreated lacrimal duct obstruction. Accumulation of bacteria in the sac causing swelling of the sac and spreading to surrounding tissues.

Lacrimal Duct Obstruction Treatment in Turkey

For lacrimal duct obstruction surgery planning, pricing information, and detailed consultation in Ankara Turkey, you can call 05302790315 or send a message via WhatsApp.