Blocked lacrimal ducts

[craig9563]

Dear all,
There is lots of great info on this site, but I don't see any discussion at all about blocked lacrimal ducts. Can blocked nasolacrimal drainage ducts cause "dry eye" ? Has anyone out there developed dry eye due to blocked ducts? I wonder if blocked ducts could cause pooling of tears, leading to irritation of the lower eyelids. I ask because I had periodic watering and stinging eyes - nothing too major - but got referred to a surgeon who found both my ducts were blocked and he attempted to open them. I was led to believe this was a simple procedure and this would address my watering eyes. I could not tolerate the plastic tubes the surgeon inserted and they came out after one week (rather than the six weeks like they are meant to). Well, sadly, my eyes immediately became way worse after the surgery - stinging and watering way worse than before the surgery. and they have never recovered (as of 6 months post op.) . Syringing shows that the ducts are still both blocked. Several other ophthalmologists and optometrists have since found that I have inflamed lower lids and poor Meibomian gland function (the original surgeon never checked this, he only focused on the ducts). My question is: could my stinging and watering eyes have stemmed from the blocked ducts, as the surgeon assumed ?? Just don't know whether to attempt the duct surgery again - and put up with the tubes - in the hope that opening the ducts will address this stinging, or to now keep well away from any further surgery, in case it makes things even worse (as the first surgery clearly has). No one knows why I am way worse after the tear duct surgery, unless I healed over such that ducts are now even more blocked than initially. Confused. Thanks.

[sweetluce]

I started having dry eyes years ago when I had lasik surgery. I got the run around and told to use lubricating drops for years. The lasik procedure was horrible for night driving.
I went to 3 specialists because even having dry eyes now I had weeping watery tears falling out of my left eye continually. I looked horrible with swollen appearance under the eye. I was embarrassed when people questioned why was I crying. I finally was told by the 4th specialist, who had optometry and plastic surgeon specialties. He did an examination by pouring salt water in my eye and seeing if I could taste it. I did not taste anything. He stood behind me with long instruments he started probing my eye. I refused to let him go any further because it was so
painful. He finally agreed to give my problem a surgical approach. He unblocked my ducts and used a stent to re-position my ducts into my nose. The recovery was 7-10 days and very difficult.
I noticed about 4 days after the procedure here came the watery tears down my cheeks. The plan was to leave the stent in until 3 months had passed. It has been 1 month since the surgery and I know it did not work and was not effective. I emailed him and he said to hang on as long as I could because once he took the stent out

[farmgirl]

I am sorry Craig I can't really comment on your problem but you have my sincerest sympathies. I do know that watery eye can be a sign of dry eye. Your ducts are probably not completely blocked because you do have 4 ducts in the overall drainage system, 2 on the bottom and 2 on the top. I had my upper ducts permanently cauterized and have plugs on the lowers and it has been a lifesaver for me so plugged ducts is not necessarily a bad thing if it helps. Obviously in your case it is not necessary. That is why I always recommend that people considering cautery experiment first with plugs. I did that for a year before I resorted to the cautery. Even at that I am putting drops in every 1/2 hour or so all day and at night if I wake up as well.

I wanted to keep plugs in the lowers in the event that should something change and my situation improve (wishful thinking on my part as I have Sjorgen's) but unfortunatly one of the plugs did a reversal and came out (through the skin) and now that duct is permanently scarred shut.

The above stories scare me a bit in that should I ever want that duct reopened it doesn't sound like the procedure is going to be very easy nor successful.

Probably your best bet is to get those lower meibomian glands unblocked and functioning better. That is where my focus would be at this point. If you have more oils perhaps the eye won't be getting so many messages to lubricate. Just my thoughs, not backed by any scientific studies lol....cheers....F/G

[meibomian]

The lacrimal system is vital to draining debris, oil, mucin, inflammatory mediators, and other components of tear that cannot leave the eye via simple evaporation. Without a functional lacrimal system, these other components can increase in concentration and cause irritation and inflammation that can be felt as dry eye symptoms. This concept is nothing more "conservation of mass". Tear and it's various other components don't simply disappear. Even though dry eye is a complex issue, the underlying fundamental principles of science must hold true. We often forget the basics when things get complex.

More often than not and unlike what is taught or intuitive, there is generally no excess tearing, or epiphora, with a blocked lacrimal system. One may have completely open and normal lacrimal puncti (upper and lower) and lacrimal canaliculi and still have lacrimal obstruction. The reason for this can be seen by looking at the anatomy of the lacrimal system. It's the distal ends of the lacrimal system at the level of the lacrimal duct and its exit into the sinus that's usually blocked - like a chain, the amount of flow is determined by its weakest link.

When one has a DacCyocystoRhinostomy (DCR) procedure, a tube/stent is usually placed from the front to back end of the lacrimal system and while the stent is in place, there's little or no flow through the lacrimal system. It can be quite irritating to have the stents in place. Once the stent is removed, hopefully the lacrimal system will ramp up again, but as with anything in medicine, there's no guarantee that anatomic success will result in physiologic success when it comes to the lacrimal system.

It is also very true that there are many people who have very little or no symptoms with a complete nasolacrimal obstruction. There reasons for this are unclear though one may postulate that this subset may either have little active inflammation or are more resistant to inflammation and therefore do not manifest any symptoms. In the setting of MGD or lid inflammation, plugging the lacrimal system will likely exacerbate dry eye symptoms for reasons stated above.

When assessing whether there's a possible nasolacrimal obstruction, a blunt tip cannula is placed though the lower or upper punctum and saline is flushed through the "ducts". This procedure is called lacrimal irrigation and is rarely performed during a dry eye evaluation. An obstruction at the common canaliculus will result in reflux of fluid through the upper of lower punctum and little or no pain. An obstruction beyond the lacrimal sac will generally cause pain due to dilation of the lacrimal sac. The punctums themselves may be stenosed or blocked at the primary entrance point as well. There's little or no discomfort with the actual insertion of the cannula through the punctum. It's a good idea to irrigate the lacrimal system to assess for patency prior to placing any punctal plugs. After all, why place plugs if the system is already blocked?