Sometimes, more than one treatment or procedure is needed before a blocked tear duct is fully opened. If an infection is suspected, your doctor will likely prescribe antibiotics.
Many babies with congenital blocked tear duct improve on their own in the first several months of life, after the drainage system matures or the extra membrane involving the nasolacrimal duct opens up. In some cases, your ophthalmologist may recommend that you use a special massage technique to help open up the membrane covering the lower opening into your baby's nose. He or she will demonstrate how to correctly do this massage.
The purpose of massage is to put pressure on the lacrimal sac to pop open the membrane at the bottom of the tear duct. This is most easily accomplished by placing your hands on each side of the baby’s face with your index finger(s) between the inner corner of the eye and the side of the nose, pressing in and down over the lacrimal sac for a few seconds. The massage should be done once in the morning and once in the evening, and each massage should be ten strokes each. It is best to do the massage during a diaper change.
In most cases of blocked tear ducts after a facial injury, the drainage system starts working again on its own a few months after the injury, and no additional treatment is necessary. Your ophthalmologist may recommend waiting a few months after the injury before considering surgery to open the blocked tear duct.
For infants and toddlers whose blocked tear ducts aren't opening on their own, or for adults who have a partially blocked duct or a partial narrowing of the puncta, a technique using dilation, probing and irrigation may be used. An instrument is used to enlarge (dilate) the punctal openings and a narrow probe is guided through the puncta, into the tear drainage system, then through the nasal opening and removed. The tear drainage system is flushed with a saline solution to clear out any residual blockage.
A balloon catheter dilation procedure opens tear drainage passages that are narrowed or blocked by scarring or inflammation. General anesthesia is used. A narrow catheter (tube) with a deflated balloon on the tip is guided through the lower nasolacrimal duct. The doctor then uses a pump to inflate and deflate the balloon along the drainage system.
With a procedure called stenting or intubation, tiny tubes are used to open up blockages and narrowing within the tear drainage system. Again, general anesthesia is usually used. Your ophthalmologist threads a very thin tube through one or both puncta in the corner of your eye, all the way through the tear drainage system and out through your nose. A tiny loop of tubing remains at the corner of your eye, but while it is visible, it's usually not bothersome. These tubes are generally left in for three to four months, and then removed.
Surgery is usually the preferred option for people who develop blocked tear ducts. It is also effective in babies and toddlers with congenital blocked tear ducts, though usually an option only after other treatments have been tried.
Dacryocystorhinostomy is the surgical procedure usually used to treat most cases of blocked tear ducts in adults and rarely in children. This technique creates a new route for tears to drain out through your nose normally again by developing a new connection between your lacrimal sac and your nose. This new route bypasses the duct that empties into your nose (nasolacrimal duct), which is typically the blockage site. Stents or intubation typically are placed in the new route while it heals, and then removed three or four months after surgery. The steps in this procedure will vary depending on your particular tear duct blockage.
Depending on the type of blockage, your surgeon may recommend creating an entirely new route from the inside corner of your eyes (puncta) to your nose, bypassing the tear drainage system altogether. This reconstruction of your entire tear drainage system is called conjunctivodacryocystorhinostomy.
To prevent postoperative infection and inflammation, you will need to use a nasal decongestant spray and eye drops. After about three to six months, your ophthalmologist will remove any stents that were put in place to keep the new channel open while healing.
If a tumor is causing your blocked tear duct, surgery may be performed to remove the tumor, or other treatments may be used to shrink it.