The lacrimal apparatus is what is responsible for creating tears and moving them from the eyes to the nose. It is possible for the lacrimal system to become obstructed and prevent tears from draining naturally. This is known as nasolacrimal duct obstruction. When tears cannot drain, this can present as excessive tearing, or epiphora, and it can occur either intermittently or continuously.
Excessive clear tearing is the most common symptom of nasolacrimal duct obstruction. Occasionally it will also be accompanied by a mucus discharge from the eyes. Dacryocystitis is a less common symptom — this is an infection of the region between the eye and nose, and can occur repeatedly in those with a lacrimal blockage. Patients with dacryocystitis often report tenderness in the area between the eye and nose.
There are several possible causes for nasolacrimal duct obstruction. The most obvious is facial trauma, which can create scarring inside of the lacrimal apparatus or tear the nasolacrimal duct. In surgery to correct facial trauma deformities, injury to the lacrimal apparatus may occur unintentionally. Other types of facial surgery such as sinus surgery and head and neck cancer surgeries can also injure the lacrimal system.
Another cause of nasolacrimal duct obstruction is bacterial infection, which leads to inflammation within the duct. Infection and inflammation can lead to scarring, which can reduce passage within the duct or block it entirely. Autoimmune diseases can also cause inflammation in the nasolacrimal duct, which can create a blockage without any infection.
Although the above causes are easy to understand, more often than not, nasolacrimal duct obstruction occurs without any apparent cause. Middle-aged individuals are most likely to experience it, and some researchers believe osteoporosis and hormone changes may play a role.
To determine if you have an obstruction in your nasolacrimal duct, a rhinologist may apply fluorescent dye in the corner of an eye to see if saline is transferring into your nose. If the dye is not noticeably passing through your lacrimal apparatus, an injection of the same substance may be attempted into the tear duct. If the duct still appears obstructed, an x-ray can be used to determine the location of obstruction.
If there is a physical obstruction, your rhinologist may perform a dacryocystorhinostomy (DCR) to remove it. A DCR creates a direct opening from the lacrimal sac (within the lacrimal apparatus) to the nasal cavity. The opening is held open with either sutures or stents, and it allows the tears to drain naturally into the nasal cavity. The procedure can be done externally, through an incision between the nose and eye, or endoscopically, which can be less painful and won’t leave any visible scarring. DCR is a procedure with minimal risks and postoperative effects. Patients can expect minimal bleeding and some scarring within the nose, and those who have the procedure enjoy a 90 percent success rate.
If you are having issues with excessive tearing, please call and make an appointment with one of the specialists at Nevada ENT and the Reno Tahoe Sinus Center. We can help determine the source of your symptoms and give you information on treatment options individually tailored to your situation.
Sources: Epiphora, American Rhinologic Society
Kevin C. Welch, MD
Dacryocystorhinostomy (DCR), American Rhinologic Society
Vijay Ramakrishnan, MD
Todd Kingdom, MD