TEARING & BLOCKED TEAR DUCTS
The tear duct allows for continual drainage of our tears between the eyes and the nose. If there is a problem anywhere along this drainage pathway, patients may present with tearing. As such, tearing is a fairly common symptom in both children and adults.
Approximately 4% of all children will be born with a blocked tear duct. Fortunately, it resolves by one year of age in most cases. It is caused by an incompletely developed tear duct, and so most children are noted to have a watery eye since birth. In children, blocked tear ducts present with watery eyes, discharge, and/or recurrent eye infections (‘pink eye’) (Figure 1a, 1b). This is usually worsened in conditions that cause increased tear production such as wind and cold. Rarely, it can progress into a facial cellulitis (Figure 2).
Tearing in adults is also most commonly due to a blocked tear duct, but can also be caused by other issues, such as eyelid problems or dry eye syndromes (Figure 3). In contrast to children, the normally developed tear duct in adults becomes increasingly more narrow (over many years) until the point at which the tear production exceeds tear drainage and patients develop symptomatic tearing. If left untreated, adults can also develop worsening of their tearing in the wind and cold, as well as recurrent discharge and infections. (Figure 4)
Treatment is dependent on the age of the patient and corresponding pathology. Children with blocked tear ducts may only need a simple probing to relieve the symptoms. Sometimes soft silicone tubes are placed in the tear duct to improve outcomes. For adults, probing of the tear duct does not have a correspondingly high success rate, and so reconstruction of the entire tear duct system is usually necessary. If there is an associated eyelid condition present, this may be repaired at the same time. The success rate of surgery is between 90 – 95%.