Nasolacrimal Duct Obstruction (NLDO) is a condition where the tear duct, which drains fluid from the eye into the nasal cavity, becomes blocked. This results in excessive tearing or watery eyes. It can occur in both newborns and adults, with different causes and treatments.
1. Congenital NLDO:
o Failure of the Hasner membrane to open, which is a membrane that covers the lower end of the tear duct. This results in the tear duct not being fully open from birth.
o Affects about 5-10% of infants, but most resolve on their own within the first year.
2. Acquired NLDO:
o Chronic inflammation, such as sinus infections, allergies, or conjunctivitis.
o Age-related tissue degeneration, causing the tear duct to narrow.
o Injury, such as a broken nose or surgery around the nose and face.
o Tumors or growths in the nasal cavity or throat that compress the tear duct.
o Side effects from systemic diseases such as sarcoidosis or autoimmune diseases.
• Excessive tearing (epiphora) without any triggers such as wind or dust.
• Frequent eye discharge or mucus.
• Red and irritated eyes.
• Recurrent infections such as dacryocystitis, which can cause swelling, redness, and pus in the inner corner of the eye.
• Fluorescein Dye Disappearance Test (FDDT) to assess tear drainage.
• Irrigation and Probing to flush the tear duct.
• Endoscopic Examination of the nasal cavity.
• Dacryocystography (DCG) or CT Scan to visualize the tear duct using contrast dye.
1. In infants:
o Crigler’s Massage to help open the tear duct.
o Probing to open the tear duct if it doesn't improve within 6-12 months.
o Silicone Intubation if probing is unsuccessful.
2. In adults:
o Lacrimal Irrigation if it is just a minor blockage.
o Balloon Dacryoplasty in some cases.
o Dacryocystorhinostomy (DCR) surgery to create a new drainage pathway by connecting the tear sac to the nasal cavity.
o Jones Tube insertion as an alternative if DCR is not possible.
• Avoid touching the eyes with unclean hands.
• Maintain nasal health, such as preventing inflammation from sinusitis.
• Regular eye check-ups, especially for those with chronic watery eyes.
Surgical Treatment for Nasolacrimal Duct Obstruction (NLDO)
Surgical treatment for Nasolacrimal Duct Obstruction (NLDO) varies depending on the level of obstruction and other patient-specific factors. Generally, there are three main surgical approaches:
1. Minimally Invasive Procedures
• Lacrimal Irrigation & Probing:
o Suitable for patients with incomplete obstruction or in infants where the tear duct hasn't fully opened.
o Involves injecting saline into the tear duct or using a probe to attempt to open the passageway.
o High success rate in children, but in adults, it often only provides temporary relief.
• Balloon Dacryoplasty:
o Uses a catheter with an inflatable balloon to open the tear duct.
o Suitable for partial blockages, particularly in children or patients who are not candidates for major surgery.
o Success rate in adults is relatively low.
• Silicone Intubation:
o Insertion of a small tube through the tear duct to help keep it open.
o Used when irrigation or probing is unsuccessful.
o The tube is typically removed within 3-6 months.
2. Creating a New Tear Drainage Pathway (Dacryocystorhinostomy, DCR)
DCR surgery is the gold standard for permanently treating NLDO. It creates a new drainage pathway from the tear sac directly into the nasal cavity, bypassing the blocked tear duct.
• External DCR:
o A traditional and well-established procedure.
o The surgeon makes a small incision near the inner corner of the eye (about 10-15 mm) and removes bone to create a new channel.
o Very high success rate (over 90-95%).
o Disadvantage: Leaves a scar near the inner corner of the eye.
• Endoscopic DCR:
o Uses an endoscope inserted through the nasal passage, eliminating the need for skin incisions.
o No visible scarring on the face.
o Increasingly popular, especially for patients who prefer to avoid facial scars.
o Success rate is similar to external DCR (90-95%).
o Requires a skilled endoscopic surgeon and may involve laser assistance.
• Laser DCR:
o Uses a laser to create the tear drainage channel instead of bone removal.
o Advantages: Less invasive and less bleeding.
o Lower success rate than standard DCR and higher risk of recurrent blockage.
3. Artificial Tear Duct Insertion (Conjunctivodacryocystorhinostomy, CDCR)
• Used in cases of severe tear duct obstruction or when the blockage is caused by tumors or severe scarring.
• Involves implanting a Pyrex tube (Jones Tube) to allow fluid to drain from the eye into the nose.
• High success rate, but requires careful maintenance and monitoring for infection.Absolutely! Here's the English translation of the summary you provided:
Summary: Which treatment is best?
The best treatment for a blocked tear duct depends on several factors, including age, cause of the blockage, severity of symptoms, and patient preferences.
Considerations:
• Probing & Irrigation: Simple, non-surgical, but may only provide temporary relief. Success rates are lower in adults than children.
• Balloon Dacryoplasty: Minimally invasive, suitable for children, but has a low success rate in adults.
• Silicone Intubation: Can be used with DCR, but requires removal later.
• External DCR: High success rate, most common procedure, but leaves a scar near the inner corner of the eye.
• Endoscopic DCR: No visible scars, faster recovery, but requires a skilled surgeon.
• Laser DCR: Quick, bloodless, but prone to repeat blockages.
• CDCR (Jones Tube): Used for severe blockages, requires careful tube maintenance.
Recommendations:
• For children: Probing & Irrigation or Balloon Dacryoplasty may be the first options. If unsuccessful, Silicone Intubation or External DCR may be considered.
• For adults: Endoscopic DCR or External DCR have high success rates. Endoscopic DCR may be preferred due to no visible scars.
• For severe blockages: CDCR (Jones Tube) may be the last resort.
Important Notes:
• Consult an ophthalmologist: Consult an ophthalmologist to evaluate your condition and choose the most appropriate treatment.
• Surgeon's expertise: If choosing Endoscopic DCR, select a surgeon with expertise and experience in this procedure.
• Realistic expectations: Understand the pros and cons of each method and set realistic expectations.
VDO explains tear duct surgery using endoscopic methods. https://youtu.be/7lTQLGlH2FI?si=jxyZ0olPZ7i_gBQP
