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Nasolacrimal Duct Obstruction

Blockage of tear drainage system causing chronic epiphora and recurrent dacryocystitis.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Göz Hastalıkları department. Book Appointment →

What is Nasolacrimal Duct Obstruction?

Nasolacrimal duct obstruction (NLDO) is blockage of the tear drainage pathway between the lacrimal puncta and the nasal cavity, causing tears to overflow onto the cheek (epiphora). Congenital NLDO affects up to 20% of newborns due to imperforate membrane at the valve of Hasner; most resolve spontaneously by 12 months.

Acquired NLDO predominantly affects older adults, particularly postmenopausal women, due to involutional stenosis. Other causes include trauma, chronic dacryocystitis, sinus surgery, radiation, granulomatous diseases (sarcoidosis, granulomatosis with polyangiitis) and lacrimal sac tumors. Untreated obstruction predisposes to recurrent acute dacryocystitis with potential orbital cellulitis.

Symptoms

Constant tearing (epiphora)
Mucoid or mucopurulent discharge
Crusting on eyelashes upon waking
Chronic conjunctival irritation
Recurrent conjunctivitis on affected side
Painful swelling at medial canthus (dacryocystitis)
Pus expression on pressure over lacrimal sac
Skin maceration from continuous tearing

Risk Factors

Congenital incomplete canalization (infants)
Female gender and postmenopausal status
Prior facial trauma or fractures
Chronic sinusitis and nasal pathology
Previous endoscopic sinus surgery
Radiation therapy to head and neck
Granulomatous diseases (sarcoidosis, GPA)
Lacrimal sac tumors (rare)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent tearing despite no obvious cause
  • Recurrent eye discharge or conjunctivitis
  • Painful red swelling at inner corner of eye
  • Fever with periorbital cellulitis
  • Tearing in infant beyond 12 months age
  • Vision blurring from constant tearing

Treatment Methods

01
Fluorescein dye disappearance test
02
Lacrimal probing and irrigation to localize obstruction
03
Dacryoscintigraphy or dacryocystography for complex cases
04
Lacrimal sac massage in infants under 12 months
05
Topical antibiotics for active infection
06
Probing and intubation for persistent congenital NLDO
07
External or endoscopic dacryocystorhinostomy (DCR) in adults
08
Balloon dacryoplasty for partial obstruction
09
Treatment of acute dacryocystitis with systemic antibiotics
10
Excision of lacrimal sac tumors when present

Which Department to Visit?

You can visit our Göz Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Göz Hastalıkları Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.