Lacrimal system disorders are conditions that affect tear production, distribution across the ocular surface, or drainage into the nasal cavity. Disorders within this system may cause dry eye, persistent watering, discharge, and recurrent infections. Sometimes the symptoms result from insufficient tear production, while in other cases the existing tears cannot drain through the ducts. As watering may occur in both situations, the problem must be identified accurately before treatment. The causes and treatment methods may differ between infants and adults. The appropriate approach is determined according to the examination findings and the function of the lacrimal drainage system.
How Does the Lacrimal System Work?
Tears moisten the ocular surface and form a protective layer against external factors. The fluid produced by the lacrimal gland is distributed across the cornea and conjunctiva through blinking. The meibomian glands in the eyelids also contribute to the oily layer that prevents tears from evaporating too quickly. Used tears pass through small openings on the inner part of the eyelids into the lacrimal canaliculi. From there, they reach the lacrimal sac and then the nasolacrimal duct, which opens into the nose. A problem at any stage of production, distribution, or drainage may lead to different symptoms.
What Causes Tear Duct Obstruction?
Tear duct obstruction occurs when the pathway that carries tears into the nose becomes narrowed or blocked. In infants, the most common cause is the failure of the thin membrane at the nasal opening of the duct to open after birth. In adults, age-related narrowing, chronic inflammation, and previous infections may contribute to obstruction. Facial trauma, nasal and sinus surgery, certain medicines, or structural changes in the lacrimal drainage system are also among the possible causes. Narrowing of the lacrimal puncta and eyelid malpositions may produce similar symptoms. Underlying structural problems are assessed separately, particularly when symptoms are unilateral and progressively worsening.
Does a Watery Eye Always Mean an Obstruction?
A watery eye does not always mean that the tear duct is blocked. When the ocular surface is irritated by dry eye, excess tears may be produced as a protective response. Allergies, eyelash problems, ocular surface inflammation, and foreign bodies may also cause watering. Outward turning of the eyelids or an impaired blinking mechanism may make it difficult for tears to reach the duct. A decision for surgical treatment is therefore not based solely on watering. Treatment is planned by assessing the condition of the ocular surface together with the patency of the lacrimal drainage system.
Symptoms of Lacrimal System Disorders
Persistent watering is one of the most common symptoms of lacrimal system disorders. Tears may run down the cheek, and symptoms may become more noticeable in cold or windy conditions. Discharge, sticky secretions, and recurrent redness may occur at the inner corner of the eye. If the lacrimal sac becomes infected, painful swelling and tenderness may develop in the area of the eye close to the nose. In problems associated with dry eye, burning, stinging, blurred vision, and a foreign-body sensation may be more prominent. Bloody tears, persistent swelling, or recurrent infections may require a more detailed examination.
Tear Duct Obstruction in Infants
Tear duct obstruction in infants is generally noticed through watering and discharge during the first period after birth. When the tear duct has not opened fully, fluid accumulates on the ocular surface and sticky discharge may form on the eyelid. As the duct may open spontaneously over time in some infants, monitoring and appropriate care may be sufficient. The duration of the symptoms, the presence of infection, and the examination findings determine the treatment plan. Findings such as sensitivity to light, noticeable enlargement of the eye, or corneal clouding should also be assessed for other eye conditions. Interventional methods may be considered if symptoms are persistent or severe.
What Is Inflammation of the Lacrimal Sac?
When the tear duct is blocked, fluid accumulating in the lacrimal sac may create a suitable environment for microorganisms to multiply. This infection, called dacryocystitis, presents with redness, pain, and swelling at the inner corner of the eye. Some patients may have purulent discharge from the eye and develop a fever. Depending on the severity of an acute infection, oral or intravenous antibiotic treatment may be required. If an abscess develops, additional procedures are considered, and treatment of the permanent obstruction is planned at an appropriate time. Increasing swelling, fever, and redness spreading around the eye require prompt medical assessment.
How Is Tear Duct Obstruction Diagnosed?
During diagnosis, the onset of symptoms, whether they affect one or both eyes, and any history of infection are assessed. A slit-lamp examination is used to examine the ocular surface, eyelids, and lacrimal puncta. Special dye tests may be performed to assess how quickly tears drain from the eye. Irrigation of the lacrimal drainage system with saline provides information about the presence and possible location of an obstruction. Nasal endoscopy or imaging methods may be used when necessary. If dry eye is suspected, tests measuring tear volume and tear-film stability are added to the diagnostic assessment.
How Is Dry Eye Treatment Planned?
Reduced tear production or rapid tear evaporation may cause dryness of the ocular surface. Treatments may include artificial tear drops, eyelid hygiene, and warm compresses where appropriate. If there is meibomian gland dysfunction or inflammation of the ocular surface, treatment is arranged accordingly. In some patients, plugs may be inserted into the lacrimal puncta to help tears remain on the ocular surface for longer. However, this treatment may not be suitable for people with tear duct obstruction or an active lacrimal sac infection. Dry eye treatment and the treatment of drainage obstruction should therefore be assessed separately.
Massage and Medical Treatment in Infants
Special massage applied to the lacrimal sac in infants may help open the membrane in the lower part of the duct. The direction, frequency, and pressure of the massage should follow the technique demonstrated during the examination. Discharge and crusting around the eye may be removed gently with a clean cloth. Antibiotic eye drops may be used when considered necessary if purulent discharge is present. Although antibiotics help control the infection, they do not open the tear duct directly. If symptoms persist or recurrent infections occur, subsequent treatment options are considered.
Probing and Duct Irrigation
Probing may be performed when the tear duct does not open spontaneously or symptoms are significant. During this procedure, a fine instrument is advanced through the lacrimal punctum to reach the blocked section of the duct. The aim is to open the membrane or narrowing that prevents tears from passing into the nose. Irrigation of the lacrimal drainage system during the procedure helps assess the patency of the duct. The timing of the procedure and the type of anaesthesia are determined according to the child's age, examination findings, and characteristics of the obstruction. Probing may not produce the same outcome in every patient, and additional procedures may be required in some cases.
Balloon and Silicone Tube Procedures
Balloon dilation may be considered in some tear duct obstructions to widen the narrowed area. The balloon is placed inside the duct and inflated in a controlled manner to widen the passage. Silicone tube placement is another option for recurrent or more complex obstructions. The silicone tube helps keep the lacrimal drainage pathway open during healing. The length of time the tube remains in place is determined according to the examination and follow-up findings. These procedures are not required for every obstruction, and the method is selected according to the location of the problem.
Tear Duct Surgery
Tear duct surgery includes surgical procedures considered for patients with persistent drainage obstruction and ongoing symptoms. The location of the obstruction, previous treatments, history of infection, and condition of the eyelids are considered during surgical planning. Narrowing of the lacrimal puncta may sometimes be treated with different and more limited procedures. For permanent obstructions in the lower sections of the drainage pathway, a new passage may need to be created between the lacrimal sac and the nose. If watering is caused by an eyelid malposition, correction of the eyelid structure may be planned first. Not every complaint of watering therefore requires the same surgical method.
How Is Dacryocystorhinostomy Performed?
Dacryocystorhinostomy involves bypassing the blocked tear duct and creating a new passage between the lacrimal sac and the nasal cavity. Also known as DSR or DCR, this procedure is performed to restore the drainage of tears into the nose. The operation does not increase tear production and is not used to treat dry eye disease. It may be performed through a small external skin incision or using an endoscopic approach through the nose. In suitable patients, a temporary silicone tube may be placed to help maintain the newly created pathway. The surgical approach is determined according to the nature of the obstruction and the patient's general condition.
Differences Between External and Endoscopic Surgery
In the external approach, a small incision is made near the nose at the inner corner of the eye to reach the lacrimal sac. In the endoscopic method, the surgical route is through the nose, and no external skin incision is made. The nasal structure, previous surgeries, and characteristics of the obstruction may affect the choice of method. In some cases, laser-assisted procedures may also be considered as part of surgical planning. No method is unconditionally more suitable than another for every patient. The expected benefits and possible limitations are assessed together according to the examination findings.
How Is the Decision for Surgery Made?
The need for surgery is determined according to the extent to which the symptoms affect daily life and the cause of the obstruction. Recurrent lacrimal sac infections or persistent watering may require a surgical option to be considered. If an active infection is present, controlling the condition and selecting the appropriate timing for the procedure are planned first. The use of blood-thinning medicines, risks associated with anaesthesia, and structural problems within the nose are reviewed before surgery. Advanced age alone is not considered a barrier to surgery. If a mass or another structural condition is suspected, treatment is planned according to the underlying cause.
Possible Risks of Treatment
Procedures involving the lacrimal drainage system may carry risks such as bleeding, infection, and temporary swelling. The newly created passage may also narrow or close again during healing. In patients with a silicone tube, the tube may become displaced, cause irritation, or come out early. Surgery performed using an external approach may leave a scar at the incision site. Watering may not resolve completely in some patients, or an additional procedure may be required. Potential risks are assessed before surgery according to the patient's anatomy and the selected method.
Postoperative Recovery and Care
Mild swelling, tenderness around the eye, or limited nasal bleeding may occur after surgery. Prescribed eye drops and nasal sprays should be used as instructed during recovery. It is important not to rub the eye and, when advised, to avoid forceful nose blowing. The time for returning to heavy lifting, strenuous exercise, and daily activities may vary according to the procedure performed. If a silicone tube has been inserted, its position and the timing of its removal are assessed during follow-up examinations. Prompt assessment is required if increasing pain, heavy bleeding, fever, or a significant change in vision develops.
Can the Tear Duct Become Blocked Again?
The tear duct or the new passage created through surgery may become narrowed again over time. Excessive scar tissue formation, ongoing inflammation, and structural factors within the nose may contribute to this condition. Recurrent watering or signs of infection require the patency of the drainage pathway to be reassessed. Follow-up examinations help identify potential problems at an early stage. In some cases, medical treatment, reopening the drainage pathway, or an additional surgical procedure may be considered. The approach is determined according to the location of the obstruction and the characteristics of previous procedures.
Treatment of Lacrimal System Disorders in İzmir
When assessing lacrimal system disorders in İzmir, symptoms of watering, dryness, and infection are considered together. For patients attending from Konak and surrounding areas, the ocular surface, eyelids, and lacrimal drainage pathways are examined in detail. Treatment approaches differ between congenital tear duct obstruction in infants and acquired obstruction in adults. Depending on the examination results, monitoring, medical treatment, probing, silicone tube placement, or surgical options may be considered. The patient's age, general health, and duration of symptoms are taken into account when making the treatment decision. Planning is based on the person's needs and the lacrimal system disorder identified.
Prices for the Treatment of Lacrimal System Disorders
Prices for the treatment of lacrimal system disorders may vary according to the type of problem and the scope of the planned procedure. Examination findings, required tests, and whether the procedure is surgical may affect the assessment. Procedures such as probing, silicone tube placement, and dacryocystorhinostomy have different planning processes. Anaesthesia requirements and additional procedures may also change the scope of treatment. It is therefore not possible to provide a single fee that applies to everyone before an assessment has been performed. You can contact the clinic through the website to obtain information about lacrimal system disorders and suitable treatment options.
