Dacryostenosis can be present from birth (congenital) or develop after birth (acquired). Either type can lead to tearing or an infection of the tear (lacrimal) sac (dacryocystitis).
Congenital dacryostenosis can result from inadequate development of any part of the nasolacrimal ducts. Most often, the far end of the nasolacrimal duct is blocked. The result is an overflow of tears that run down the cheek (epiphora) or causes persistent crusting. One or both eyes can be affected.
The problem is usually first noticed in 3- to 12-week-old infants. This type of blockage usually disappears without treatment by the age of 6 to 9 months, as the nasolacrimal system develops. Until the child is about 1 year old, doctors often suggest that parents gently massage the tear sac 4 or 5 times per day to help relieve the blockage.
If the blockage is not relieved by the time the child is about 1 year old, an ear, nose, and throat specialist (otorhinolaryngologist) or an eye specialist (ophthalmologist) may have to open the nasolacrimal duct with a small probe, which is usually inserted through the duct opening (punctum) at the inner corner of the eyelid near the nose. The child is usually given a general anesthetic for this procedure.
Acquired dacryostenosis is often a result of age-related narrowing of the duct. It can also result from scarring after an injury or surgery or from disorders that cause inflammation such as sarcoidosis or granulomatosis with polyangiitis (formerly called Wegener granulomatosis). Simply inserting a probe, as is done with congenital dacryostenosis, is usually not effective. If dacryostenosis causes persistent, bothersome tearing or repeated episodes of infection, surgery (dacryocystorhinostomy [DCR]) to create a passage between the tear sac and the nose may be needed.