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Nasal Lacrimal Duct (NLD)

What is overflow tearing?

Overflow tearing, or NLD (Nasal Lacrimal Duct) obstruction is a congenital stenosis of the nasal lacrimal drainage system. It is a common condition in infants and babies. Approximately one in three infants are born with an overabundance of tears and mucus. It is also quite common for babies' eyelashes to stick together after sleep, a situation which can cause the eye(s) to become chronically infected.

How do tears drain from the eye?

Tears drain from the eyes through two small openings called the upper and lower punctum, which are located along the upper and lower eyelids near the nose. They then flow through the canaliculus into the lacrimal sac located under the skin on the side of the nose.

From the sac, the tears are pumped by the blinking action of the lids into the tear ducts. These ducts go through the side bones of the nose and empty the tears into the back of the nose. That's why the nose runs when we cry.

What causes overflow tearing?

Overflow tearing is usually caused by the presence of a persistent membrane that blocks the lower end of the tear duct inside the nose. Normally, this membrane stretches or pops open at or before birth. In many infants, however, it is still closed at birth, clogging the tear drainage system. The blockage may open spontaneously in a few months as the infant grows. Approximately 85% of blocked tear ducts open spontaneously by the age of 6 months.

Are there any other causes of overflow tearing?

Rarely, overflow tearing can be caused by congenital glaucoma. There are other signs and symptoms associated with this condition, such as an enlarged eye, clouded cornea, high pressure in the eye, light sensitivity, and infant irritability. Smoke, pollen, wind, or chemical eye irritation can also cause overflow tearing.

How is overflow tearing treated?

Initially, the physician may recommend antibiotic eye drops or ointment used once or twice daily, along with pressure or massage over the tear sac. Massaging the tear sac is only helpful if pus is expressed during the procedure.

To apply pressure, place a finger under the inner corner of the infant's eye next to the nose, and roll the finger over the bony ridge while pressing down and in against the bony side of the nose. This expresses mucus and tears from the sac. Following pressure on the sac, place an antibiotic in the eye. Most tear blockages in infants will disappear by six months of age. If the tearing persists, it may be necessary for the physician to open the tear ducts by probing and irrigation. In-office probing can be performed in infants under the age of 9 months.

How is probing on the tear duct performed?

The probing is performed by using a thin, blunt metal wire, which is gently passed through the tear drainage system into the nose to ensure that the pathway is open. Infants experience no pain after the probing, but some blood staining of the tears or nasal secretion is common, and a discharge from the eye may be present for up to a week. Antibiotics may be prescribed. Obstructions can recur, and a repeated probing may be necessary in some cases (Up to 15%). In-office probings are performed on fasting children. (The child should fast for four hours prior to the procedure to prevent the risk of aspiration pneumonia.)

If probing is not successful, plastic or silicone tubes can be placed in the drainage canal. This is a longer procedure than probing and requires general anesthesia. Occasionally, further surgery is needed to bypass the blocked tear duct and create a new opening through the bone into the nose.

What complications can occur with treatment?

As with any surgical procedure, there is the possibility of infection or bleeding. Scarring can re-obstruct the opening, requiring additional surgery. Chronic obstruction can lead to infections of the tear sac at any age.

For more information, please contact the patient advisor by phone at 330-747-2733 or by email at info@eyecareassociates.com.