Nasolacrimal Duct Obstruction

What are the signs and symptoms of nasolacrimal duct obstruction?

The most common sign of nasolacrimal duct obstruction is increased tearing on the affected side. Tears are normally supposed to drain through the nasolacrimal duct to the inside of the nose; but if the duct is obstructed, tears will overflow from the eyelids and run down the cheek.

Some patients may have crusting of their eyelashes with a yellow-green discharge, and their eyes or eyelids may become red. This is because the normal bacteria growing on the eyelids and eyelashes is unable to be flushed through the nasolacrimal duct if it is obstructed. Sometimes this buildup of bacteria can lead to a serious infection of the tear drainage pathway called dacryocystitis.

How do we diagnose nasolacrimal duct obstruction?

Nasolacrimal duct obstruction is generally a clinical diagnosis, meaning that the diagnosis can be made without the need for invasive tests or imaging. Your child’s pediatric ophthalmologist or optometrist can make the diagnosis by simply examining the child’s eyes and eyelids and discussing the patient’s symptoms with the child’s parent or guardian.

How is nasolacrimal duct obstruction treated?

In approximately 90% of babies born with a nasolacrimal duct obstruction, the duct will eventually open on its own before the child’s first birthday. However, in children whose nasolacrimal ducts remain obstructed a year after birth, studies have shown that their ducts may not open on their own for several years.

At Children’s Hospital Colorado, when we diagnose a child with a nasolacrimal duct obstruction before their first birthday, we generally recommend waiting until the child turns 1 year old to see if the obstruction will resolve on its own.

If the nasolacrimal duct obstruction has not resolved by 1 year old, we generally recommend a surgical procedure to open the duct and relieve the child’s symptoms. The procedure consists of passing a series of very thin wire probes through the punctum of the eyelid (the tiny natural opening to the nasolacrimal duct found on the inside corner of each eyelid) and advancing the wire probe through the nasolacrimal duct into the inside of the nose. The wire probe is then removed, leaving the duct open and allowing tears to flow naturally through the nasolacrimal duct and into the nose. This procedure is performed in an operating room under general anesthesia, so your child will feel no discomfort or anxiety during the procedure.

After performing this procedure, your child’s pediatric ophthalmologist may choose to leave a tiny silicone stent in the duct for 3 to 6 months in order to keep the duct open and prevent it from scarring closed again. The stent is placed in the operating room at the same time as the probing procedure, but the stent can be easily removed in the clinic without requiring any anesthesia. The child cannot feel the stent and usually has no idea it is there.

Your pediatric ophthalmologist may also choose to perform a procedure called balloon dacryoplasty, in which a long, thin balloon is advanced through the nasolacrimal duct and then repeatedly inflated and deflated, thereby stretching and enlarging the nasolacrimal duct so that it remains open long after the procedure.

Why choose us for treatment of nasolacrimal duct obstruction?

At Children’s Colorado, our team of pediatric ophthalmology experts has cared for thousands of children with nasolacrimal duct obstruction and we perform over a hundred surgical treatments for nasolacrimal duct obstruction each year. If your child requires surgery for their nasolacrimal duct obstruction, you can be assured that at Children’s Colorado, they will be cared for by a team of ophthalmologists, nurses, anesthetists and technicians who are trained specifically in the care of pediatric patients. This ensures that your child’s procedure will be as safe, effective, and stress-free as possible.