UNDERSTANDING THE LACRIMAL DUCT: ALLEVIATE YOUR SYMPTOMS AND RESTORE VISUAL COMFORT
Many people have questions and seek information about the “lacrimal duct”, a structure essential for the health and comfort of our eyes. Problems with this small but vital drainage pathway can cause uncomfortable symptoms and significantly affect quality of life. In this article, Dr. Miguel Lopes Oliveira, MD, DDS, Maxillofacial Surgeon, aims to clarify what it is, the most common symptoms, and the approaches to treatment, always using clear and accessible language, so you can better understand this condition and know when to seek specialist help.
📘 View article summary
- The function of the lacrimal duct is to drain tears into the nasal cavity.
- Symptoms of lacrimal duct problems affect quality of life.
- Causes of obstruction include abnormalities, infections, and trauma.
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What is the Lacrimal Duct and What is its Function?
The lacrimal duct, or lacrimal drainage system, is a network of small ducts responsible for draining tears from the eyes into the nasal cavity. Tears are produced by the lacrimal glands and have the crucial function of lubricating, nourishing, and protecting the ocular surface, removing impurities and irritants. After fulfilling their function, tears are collected by small openings (lacrimal puncta) located in the inner corners of the eyelids, flowing through the lacrimal canaliculi to the lacrimal sac and finally down the nasolacrimal duct into the nose. It is a delicate but fundamental system for maintaining ocular moisture balance and preventing excessive watering or tear accumulation.
When there is an obstruction or dysfunction in the lacrimal duct, the normal flow of tears is compromised, leading to a series of problems. The causes for this obstruction can be diverse, ranging from congenital abnormalities affecting duct development to infections, inflammation, facial trauma, or natural ageing. Understanding the anatomy and function of the lacrimal duct is the first step in identifying signs that something is wrong and seeking evaluation from a specialist. The complexity of the facial structures, where the lacrimal duct is located, requires in-depth knowledge for accurate diagnosis.
Common Symptoms of Lacrimal Duct Problems
Lacrimal duct problems manifest through symptoms that, although sometimes subtle, can be quite disturbing. The most evident is excessive watering (epiphora), where tears run down the face, even without apparent crying or irritation. This excess moisture can lead to irritation of the eyelid and facial skin, as well as intermittent blurred vision. Other signs include the accumulation of discharge in the corner of the eye, especially in the morning, and the sensation of having something in the eye. In some cases, an infection of the lacrimal sac, known as dacryocystitis, can occur, presenting with pain, swelling, and redness in the area between the eye and the nose, which may even lead to an abscess.
It is important to note that some of these symptoms can be mistaken for other eye conditions, such as dry eye. Although it may seem contradictory, severe dry eye can sometimes trigger reflex tearing as a defence mechanism. Studies show how genes linked to inflammation affect dry eye [1], highlighting the complexity of conditions affecting the ocular surface and the need for careful differential diagnosis. The persistence of any of these symptoms, or their intensification, is a clear indicator that medical evaluation is necessary. Lacrimal duct issues require a professional approach to identify the cause and define the appropriate treatment.
How is a Medical Evaluation Performed?
The evaluation of a lacrimal duct problem begins with a detailed discussion about the patient’s medical history and presented symptoms. Dr. Miguel Lopes Oliveira, with his expertise in maxillofacial surgery, performs a thorough physical examination of the face and eyes. This examination includes observing the eyelids, lacrimal puncta, and the lacrimal sac area. Specific tests may be carried out to assess the drainage system’s function, such as the fluorescein clearance test, where a dye is applied to the eye to check drainage time.
In some cases, to confirm the diagnosis and determine the exact location and cause of the lacrimal duct obstruction, further investigations may be necessary. These can include irrigation of the lacrimal pathways with saline solution to check for patency, or imaging studies such as dacryocystography (a type of X-ray with contrast), computed tomography (CT) scans, or magnetic resonance imaging (MRI) of the facial and orbital region. These diagnostic tools allow the specialist to visualise internal structures and identify abnormalities, tumours, or scarring that may be causing the blockage. Research analyses how glands affect dry mouth in autoimmune diseases [2], underscoring the importance of considering systemic conditions that can impact tear production and, consequently, lacrimal duct health.
Treatment Options for the Lacrimal Duct
Treatment options for lacrimal duct problems vary widely, depending on the cause and severity of the obstruction. In infants with congenital obstruction, the condition often resolves spontaneously within the first few months of life, or with gentle massage of the lacrimal sac area. If the obstruction persists, probing, a simple procedure to open the duct, may be necessary. In adults, treatment can be more complex. If there is an infection (dacryocystitis), the first step is antibiotic treatment.
For persistent or recurrent obstructions, surgical intervention is often the most effective solution. One of the most common surgeries is dacryocystorhinostomy (DCR), which creates a new pathway for tears to drain from the lacrimal sac directly into the nasal cavity, bypassing the obstruction. This procedure can be performed externally (with a small skin incision) or endonasally (through the nose, with no visible external incision), using minimally invasive techniques. The choice of technique will depend on the specialist’s assessment and the specific characteristics of the patient’s case. A review shows that treatments can alleviate dry eye, even without active effect [3], emphasising the need for accurate diagnosis to ensure treatment is directed at the actual cause of discomfort, whether it be a lacrimal duct obstruction or another ocular condition.
Following an intervention to treat a lacrimal duct problem, recovery is generally progressive and requires specific care. If the obstruction was resolved through probing, recovery is rapid and symptom relief is almost immediate. In the case of surgery such as DCR, patients can expect some swelling and discomfort in the nasal and ocular area in the first few days, which are managed with medication. It is common for a small silicone tube to be temporarily left in the newly created duct to keep it open, being removed a few weeks or months later in a simple and painless procedure. Ocular hygiene is crucial during the post-operative period, and the use of antibiotic and anti-inflammatory eye drops is often recommended to prevent infections and reduce inflammation. Lacrimal duct issues, when treated, generally have a very favourable prognosis.
It is crucial to follow all of Dr. Miguel Lopes Oliveira’s instructions to ensure proper recovery and minimise the risk of complications. Avoiding forceful nose-blowing and protecting the operated area are examples of important precautions. Follow-up appointments are essential to monitor healing and the functionality of the new drainage system. Most patients experience significant improvement in watering and ocular comfort after treatment, regaining their quality of life. Understanding what the lacrimal duct is and the available treatment options is the first step towards finding relief and well-being.
Understanding the vital role of the lacrimal duct in eye health and the symptoms associated with problems in this structure is fundamental to seeking medical help at the right time. Excessive watering, discharge, and pain are warning signs that should not be ignored. Accurate evaluation by a specialist, such as Dr. Miguel Lopes Oliveira, MD, DDS, Maxillofacial Surgeon, is essential for a correct diagnosis and for defining the most appropriate treatment plan for your specific case. His expertise in facial anatomy and surgery allows for a comprehensive and careful approach.
If you have been experiencing any of the mentioned symptoms and suspect a lacrimal duct problem, do not hesitate to seek professional advice. Timely intervention can prevent complications and restore your visual comfort, allowing you to enjoy life without the constant nuisance of tears running down your face. Your health and well-being are our priority, and we are here to guide you every step of the way towards recovery.
Each case is unique and must be assessed in person by a doctor, considering examinations, history, and individual expectations.
📚 View references
- Identification of ferroptosis-related genes in dry eye disease and their effects on inflammatory response and immune infiltration.
- Single-Cell Spatial Transcriptomic of Sjögren’s Disease Salivary Glands.
- Placebo or vehicle effects on dry eye signs and symptoms in randomized controlled trials: A systematic review and meta-analysis.