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 Dacryocystitis Dacryocystitis is infection of the tear (lacrimal) sac usually due to a blockage in the tear (nasolacrimal) duct. The tear sac is a small chamber into which tears drain. The usual cause of dacryocystitis... read more ).
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.
Where Tears Come From
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 Sarcoidosis Sarcoidosis is a disease in which abnormal collections of inflammatory cells (granulomas) form in many organs of the body. Sarcoidosis usually develops in people aged 20 to 40 years, most often... read more or granulomatosis with polyangiitis Granulomatosis with Polyangiitis Granulomatosis with polyangiitis often begins with inflammation of small- and medium-sized blood vessels and tissues in the nose, sinuses, throat, lungs, or kidneys. The cause is unknown. The... read more (formerly called Wegener granulomatosis). Chronic conjunctivitis, certain kinds of chemotherapy, side effects to certain eyedrops, autoimmune diseases, and radiation can also cause narrowing of the duct. 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.