Lacrimal Fistula 

A lacrimal fistula is an unnatural small tunnel (a tiny tube-like passage) that forms between the tear drainage system and the skin near the inner corner of the eye (the side closest to the nose). Tears are normally made by the lacrimal gland, wash over the eye, and drain through two tiny openings called puncta into channels called canaliculi, then into the lacrimal sac, and finally down the nasolacrimal duct into the nose.

A lacrimal fistula is a tiny, abnormal tunnel that forms between your tear-drainage system and the skin near the inner corner of your eye or sometimes into the nose or mouth. Tears and sticky discharge that should drain quietly into your nose instead leak out through this small opening, so you may notice constant wetness, crusts, or a drop of pus on the skin. Some people are born with a fistula (congenital), while others develop it later due to long-standing tear duct blockage, repeated infections (like dacryocystitis), injury, prior eye or nasal surgery, inflammatory diseases (e.g., sarcoidosis, granulomatosis with polyangiitis), or infections such as tuberculosis.

When a fistula exists, tears, mucus, or pus can leak out through the skin opening instead of going down into the nose. In very simple words, a lacrimal fistula is a wrong shortcut that lets eye fluid come out on the face. The tunnel may be present from birth (congenital) or may appear later in life (acquired) after infection, injury, surgery, or disease.

• In babies, a small developmental error can leave a tiny extra passage that connects the lacrimal sac or canaliculus to the skin.

• In older children or adults, pressure from infection inside the lacrimal sac can make it burst through a weak spot in the skin.

• Injuries, surgical cuts, or a tube/stent placed during tear-duct surgery can also create or maintain a track that heals as a permanent tunnel.

The fistula is usually lined by skin-like tissue (epithelium), so it stays open and does not close by itself. Because tears and sometimes infected material can drain through it, the skin around it may get wet, irritated, and infected again and again.

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Anatomy

• Puncta: two pin-point openings on the upper and lower eyelid at the inner corner.

• Canaliculi: short channels that carry tears from puncta to the lacrimal sac.

• Lacrimal sac: a small reservoir in the inner corner of the eye where tears collect.

• Nasolacrimal duct: a tube that takes tears from the sac to the nose.

• Lids and blinking: blinking acts like a pump, pushing tears through the system.

A fistula usually connects the lacrimal sac (or canaliculus) to the skin, creating leakage onto the face.

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Types of lacrimal fistula

1. Congenital lacrimal fistula
   Present at birth. A small, circular or slit-like hole sits a few millimeters below or medial to the inner canthus. It may drain clear tears or a little mucus. Some babies have no symptoms; others have constant dampness.

2. Acquired infectious fistula
   Forms after chronic dacryocystitis (long-standing infection of the lacrimal sac) or after an acute abscess that bursts through the skin. The opening often leaks mucus or pus.

3. Acquired traumatic fistula
   Occurs after cuts, lacerations, fractures, burns, or bites near the inner corner. The injury either directly creates the passage or heals in a way that leaves a tunnel.

4. Iatrogenic (treatment-related) fistula
   Appears after tear-duct surgeries (e.g., dacryocystorhinostomy, canalicular repair) or prolonged stenting where a tube erodes into the skin, creating a new pathway.

5. Canalicular fistula
   The tunnel connects the canaliculus (the short eyelid channels) to the skin, usually a bit closer to the lid margin. Touching near the canaliculus may express tears through the opening.

6. Lacrimal sac fistula
   The common type. The tract arises from the sac, usually just below the medial canthus. Compressing the sac often pushes discharge out through the fistula.

7. Nasolacrimal duct fistula
   A rarer connection from the lower part of the tear duct to the skin lower on the side of the nose.

8. Simple epithelialized tract
   A single, straight tunnel with a smooth lining. Easier to map and repair.

9. Complex or branching fistula
   Has side channels or scar tissue, often from repeated infections or surgeries. Harder to close; may need more extensive surgery.

10. Active (draining) vs. latent (quiet)
    Active fistulas leak fluid frequently. Latent ones are visible but may only drain when the sac is pressed or when infections flare up.

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Causes of lacrimal fistula

1. Congenital tract (developmental variant)
   A leftover channel from fetal development that never closed, leaving a tiny hole since birth.

2. Chronic dacryocystitis
   Long-term lacrimal sac infection increases pressure and inflammation until a new escape route forms through the skin.

3. Acute lacrimal sac abscess rupture
   A sudden, painful pus pocket in the sac bursts outward, creating a permanent tunnel that drains to the skin.

4. Trauma—cut or laceration near the inner corner
   A deep cut accidentally connects the sac/canaliculus to the skin, healing into a fistula.

5. Blunt facial trauma or fracture
   Bone or soft-tissue damage distorts the tear duct anatomy; scarred tissues later form a tunnel.

6. Burns (thermal or chemical)
   Tissue death and scarring create weak points; healing may leave a tube between the sac and skin.

7. Post-surgical complication (DCR or canalicular surgery)
   After tear-duct surgery, poor healing or stent erosion can make a new passage to the skin.

8. Stent/tube erosion
   A silicone tube placed to keep ducts open rubs through tissues over time and creates a hole.

9. Canaliculitis (often Actinomyces)
   Chronic infection inside the canaliculus causes granules and debris that break through to the skin.

10. Skin infection or cellulitis over the sac region
    Repeated skin infections and drainage open a lasting track to the lacrimal system.

11. Lacrimal sac tumors (benign or malignant)
    A growth weakens or invades the sac wall and the overlying skin, creating a draining channel.

12. Tuberculosis
    TB can involve the lacrimal sac; caseating inflammation makes a sinus that communicates with skin.

13. Granulomatosis with polyangiitis (GPA)
    A vasculitic disease causes tissue destruction around the nose and lacrimal system, forming tracts.

14. Sarcoidosis
    Granulomas affect the lacrimal sac or surrounding tissues; chronic inflammation can create a fistula.

15. Chronic rhinosinusitis
    Ongoing nasal/sinus inflammation spreads to the lacrimal sac area, encouraging tract formation.

16. Osteomyelitis of lacrimal bone
    Bone infection next to the sac erodes both bone and soft tissue, allowing an abnormal connection.

17. Radiation therapy to midface
    Radiation can thin the skin and damage small ducts, predisposing to breakdown and fistula.

18. Foreign body or retained suture
    A splinter, suture, or fragment near the lacrimal sac keeps the area inflamed until a channel opens.

19. Nasal or endoscopic sinus surgery injury
    Instruments can inadvertently injure the nasolacrimal duct/sac region and later create a tract.

20. Congenital syndromes (e.g., Down syndrome, craniofacial anomalies)
    Abnormal midface development raises the chance of extra lacrimal tracts or malpositioned ducts.

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Common symptoms and signs

1. Constant tearing (epiphora) — the eye always looks watery because tears escape the normal route.

2. Visible tiny hole near the inner corner — a dot or slit on the skin that sometimes crusts.

3. Leak of clear tears, mucus, or pus from the hole — fluid may run down the cheek.

4. Wet skin and irritation around the opening — the area looks red, soft, or chapped from moisture.

5. Crusting and bad smell — dried discharge forms crusts; infection can add an odor.

6. Swelling near the lacrimal sac — a small lump that may be tender, especially during infection.

7. Pain or soreness on pressing the area — pressure can push fluid out through the fistula.

8. Recurrent skin infections — repeated episodes of redness, warmth, and tenderness around the hole.

9. Sticky eyelids in the morning — dried discharge glues the lashes together.

10. Blurred vision that clears with blinking — a film of tears or mucus on the eye surface.

11. Tear overflow worsens in wind or cold — extra tearing exposes the leakage more often.

12. Social embarrassment or cosmetic concern — the visible hole and leakage affect self-confidence.

13. Nasal symptoms — some people also have nasal discharge or blockage if the duct and nose are inflamed.

14. Itching or burning of the skin — irritation from constant dampness and discharge chemicals.

15. History clues — past facial injury, sinus surgery, long-standing tearing, or infant symptoms since birth.

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How doctors make the diagnosis

Note: Not every person needs every test. Doctors choose tests based on age, symptoms, suspected cause, and whether surgery is being planned.

A) Physical examination tests

1. Focused inspection of the inner corner
   The doctor looks closely for a tiny skin opening, redness, crusts, or active drainage. They note the location (above/below the medial canthus) to guess whether the tract comes from the canaliculus or lacrimal sac.

2. Palpation/compression of the lacrimal sac
   Gentle pressure over the sac may express fluid. If mucus or pus exits the skin opening, it supports the diagnosis of a lacrimal sac fistula and suggests infection.

3. Fluorescein dye disappearance test (DDT)
   A drop of safe yellow dye is placed on the eye. If dye does not clear well and appears at the fistula, the tear outflow is misdirected to the skin.

4. Eyelid and punctal examination
   The doctor checks puncta size and position, lid laxity, and the canalicular area. A punctum that is scarred or turned away from the eye can contribute to mis-drainage.

5. Nasal and skin survey
   The surrounding nasal bridge and cheek skin are inspected for scars, trauma marks, dermatitis, or masses; the findings help point to causes like injury, previous surgery, or tumor.

B) Manual/bedside procedural tests

6. Lacrimal syringing (irrigation)
   Salt water is gently injected through the punctum. If fluid emerges from the fistula, it proves a direct connection. If it instead flows to the nose, the fistula may be inactive or from a different level.

7. Lacrimal probing
   A thin smooth metal probe is passed through the canaliculus to feel for obstruction or abnormal side openings. A probe may enter the fistula, mapping its path.

8. Fistula cannulation
   A very fine lacrimal probe is placed through the skin opening to see where it leads (canaliculus vs sac). This helps plan surgery by showing the origin and length of the tract.

9. Fluorescein fistula test
   Fluorescein dye is placed on the eye surface. Appearance of yellow-green dye at the skin hole confirms that tears reach the fistula.

10. Jones II test (dye recovery with irrigation)
    After placing dye on the eye, the doctor irrigates through a punctum and looks for dye-colored fluid coming out of the nose or fistula. This shows whether tears pass or are diverted.

C) Laboratory & pathological tests

11. Swab for Gram stain and bacterial culture
    Discharge taken from the fistula/sac is tested to find which bacteria are present and which antibiotics work best.

12. AFB stain, culture, or PCR for tuberculosis
    Used when symptoms are chronic, scars are sinus-like, or TB risk is high. Positive results guide anti-TB therapy.

13. Fungal KOH prep and culture
    Considered in immunocompromised patients or when granular debris and poor response to antibiotics suggest fungus.

14. Histopathology/biopsy of the tract or sac mass
    If a tumor or unusual tissue is suspected, a small sample is examined under the microscope to check for benign vs malignant disease or granulomas (e.g., sarcoid, GPA).

D) Electrodiagnostic tests  — rarely needed, explained simply

These tests check nerve function. They are not routine for lacrimal fistula but can be used if the doctor suspects nerve injury after trauma or surgery that also affects blinking and tear pumping.

15. Blink reflex EMG
    Measures the electrical response of facial nerve pathways that control blinking. Helpful if facial nerve weakness contributes to poor tear pumping.

16. Facial nerve conduction studies
    Checks how well signals travel along the facial nerve. Considered only when there is obvious nerve damage near the inner corner that might complicate tear flow.

E) Imaging tests

17. Dacryocystography (DCG)
    A contrast dye is gently injected through the punctum and X-ray/fluoroscopy outlines the canaliculi, sac, and duct. DCG can show side leakage into a fistula and pinpoint its origin.

18. Fistulography
    Contrast is injected through the skin opening itself, then X-rays are taken. This directly maps the fistula tract, shows length, direction, and branching, and reveals where it enters the lacrimal system.

19. CT scan of orbits and paranasal sinuses (± CT-DCG)
    CT shows bones, sinus disease, foreign bodies, fractures, and air–fluid levels. With contrast in the duct (CT-DCG), it can highlight leaks and abscess cavities.

20. Ultrasound of lacrimal sac/tract
    A small probe on the skin uses sound waves to show sac swelling, cysts, abscesses, or masses next to the fistula. It’s quick, painless, and has no radiation.

Non-Pharmacological Treatments

1. Warm compresses
   Description: Hold a clean, warm (not hot) cloth over the inner corner for 5–10 minutes, 3–4 times daily.
   Purpose: Soothe pain and help fluid move.
   Mechanism: Gentle heat loosens thick discharge, improves local blood flow, and helps the sac drain (even if partly blocked).

2. Lid hygiene and skin care
   Description: Twice-daily cleaning with diluted baby shampoo or a lid-wipe; apply a thin layer of plain petrolatum to protect irritated skin.
   Purpose: Reduce crusting and prevent skin breakdown around the opening.
   Mechanism: Removes bacteria and debris; barrier ointment prevents irritation from constant moisture.

3. Crigler massage (in infants with congenital issues)
   Description: Caregiver uses a clean finger to gently press and roll downward over the lacrimal sac 5–10 strokes, 3–4 times daily.
   Purpose: Encourage opening of the membrane at the bottom of the duct.
   Mechanism: Builds brief pressure that can pop open the thin distal membrane in babies.

4. Saline irrigation (doctor-guided)
   Description: In clinic, the tear passage is gently flushed.
   Purpose: Clear soft plugs and assess flow.
   Mechanism: Saline mechanically washes debris and shows whether the pathway is open.

5. Temporary protective dressing
   Description: A small hydrocolloid patch or breathable tape over the skin opening.
   Purpose: Keep clothing/masks from rubbing; limit contamination.
   Mechanism: Physical barrier reduces maceration and irritation.

6. Avoid rubbing and picking
   Description: Hands off the area; trim nails.
   Purpose: Prevents enlarging the tract and introducing germs.
   Mechanism: Reduces mechanical trauma and bacterial seeding.

7. Stop or pause contact lens wear (if used)
   Description: Switch to glasses until infection and discharge are controlled.
   Purpose: Lower infection risk and irritation.
   Mechanism: Removes a surface that can hold bacteria and irritants.

8. Humidification and nasal care
   Description: Room humidifier; isotonic nasal saline spray 2–4 times/day.
   Purpose: Soothe nasal mucosa and improve downstream tear drainage.
   Mechanism: Moist mucosa is less swollen, helping nasolacrimal drainage.

9. Treat sinus/allergy triggers (non-drug steps)
   Description: Allergen avoidance, frequent gentle nose blowing (not forceful), neti-pot with sterile saline as advised.
   Purpose: Reduce nasal swelling that worsens tear outflow.
   Mechanism: Less nasal inflammation = less back-pressure on the lacrimal system.

10. Warm shower eye steaming
    Description: Let warm steam bathe the eyes (eyes closed) a few minutes.
    Purpose: Thin secretions.
    Mechanism: Moist heat liquefies mucus.

11. Glasses or sunglasses as a shield
    Description: Wear during windy/dusty conditions.
    Purpose: Prevent irritants that trigger tearing.
    Mechanism: Physical shield lowers reflex tearing.

12. Blood sugar control (if diabetic)
    Description: Keep glucose within target.
    Purpose: Lower infection risk and improve healing.
    Mechanism: High glucose feeds bacteria and slows immune function; control helps defenses.

13. Smoking cessation
    Description: Quit smoking/vaping.
    Purpose: Reduce chronic nasal/ocular surface inflammation.
    Mechanism: Less toxic irritation = less swelling and tearing.

14. Good makeup hygiene (or temporary pause)
    Description: Remove makeup fully; avoid glitter/old mascara.
    Purpose: Prevent pore blockage and contamination around the fistula.
    Mechanism: Reduces foreign particles and bacteria.

15. Warm water eyelid rinses after outdoor activity
    Description: Rinse lids/lash line with sterile or boiled-then-cooled water.
    Purpose: Clear dust/pollen that can worsen tearing.
    Mechanism: Mechanical removal of irritants.

16. Sleep with head slightly elevated
    Description: Extra pillow.
    Purpose: Reduce overnight swelling.
    Mechanism: Less venous congestion = less morning discharge.

17. Gentle scar care after procedures
    Description: Once healed, silicone gel per surgeon’s advice.
    Purpose: Keep skin soft and reduce rubbing points.
    Mechanism: Silicone modulates collagen hydration.

18. Hygiene education for caregivers (infants/elderly)
    Description: Teach hand washing, compress technique, and signs of infection.
    Purpose: Prevent avoidable flare-ups.
    Mechanism: Better routine = fewer bacteria introduced.

19. Protective sports eyewear
    Description: Use during activities with risk of facial impact.
    Purpose: Prevent trauma that can worsen or create fistulas.
    Mechanism: Impact absorption.

20. Pre-surgical optimization
    Description: Clear any active infection, manage allergies/sinusitis, and plan post-op care.
    Purpose: Improve surgical success.
    Mechanism: Quieter tissues heal better and reduce recurrence.

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Drug Treatments

Important: Antibiotics are used when there’s active infection or surrounding cellulitis. They ease pain and lower bacterial load but do not close the fistula; surgery usually cures the problem. Always follow your eye specialist’s plan.

1. Amoxicillin-clavulanate (oral)
   Class: Beta-lactam + beta-lactamase inhibitor.
   Dose/Time: 875/125 mg by mouth every 12 hours for 5–7 days.
   Purpose: Treat common skin/tear-sac bacteria during acute infection.
   Mechanism: Stops bacterial cell-wall building.
   Side effects: Upset stomach, diarrhea, rash; rare allergy.

2. Cephalexin (oral)
   Class: First-generation cephalosporin.
   Dose/Time: 500 mg by mouth every 6 hours for 5–7 days.
   Purpose: Alternative for mild/moderate cellulitis.
   Mechanism: Inhibits bacterial cell-wall synthesis.
   Side effects: GI upset, rash; avoid if severe penicillin allergy.

3. Doxycycline (oral)
   Class: Tetracycline antibiotic.
   Dose/Time: 100 mg by mouth every 12 hours for 5–7 days.
   Purpose: Coverage including MRSA risk or if penicillin-allergic.
   Mechanism: Blocks bacterial protein synthesis.
   Side effects: Sun sensitivity, reflux; avoid in pregnancy/young children.

4. Trimethoprim–sulfamethoxazole (oral)
   Class: Folate pathway inhibitor combo.
   Dose/Time: 160/800 mg (DS) by mouth every 12 hours for 5–7 days.
   Purpose: MRSA coverage option.
   Mechanism: Dual blockade of folate synthesis in bacteria.
   Side effects: Rash, high potassium; avoid in sulfa allergy and late pregnancy.

5. Clindamycin (oral)
   Class: Lincosamide.
   Dose/Time: 300 mg by mouth every 6–8 hours for 5–7 days.
   Purpose: Skin/soft tissue infection, penicillin-allergic.
   Mechanism: Blocks bacterial protein synthesis.
   Side effects: Diarrhea; risk of C. difficile colitis.

6. Ciprofloxacin (oral)
   Class: Fluoroquinolone.
   Dose/Time: 500 mg by mouth every 12 hours for 5–7 days (select cases).
   Purpose: Gram-negative coverage when indicated.
   Mechanism: Inhibits bacterial DNA gyrase.
   Side effects: Tendon problems, neuropathy; avoid in pregnancy and growing children unless essential.

7. Moxifloxacin 0.5% (ophthalmic drops)
   Class: Fluoroquinolone eye drop.
   Dose/Time: 1 drop to affected eye 3–4×/day for 5–7 days.
   Purpose: Reduce surface bacterial load and discharge.
   Mechanism: Blocks bacterial DNA replication locally.
   Side effects: Temporary stinging, taste change.

8. Erythromycin 0.5% (ophthalmic ointment)
   Class: Macrolide eye ointment.
   Dose/Time: 0.5-inch ribbon inside lower lid at bedtime (or 2–4×/day) for 5–7 days.
   Purpose: Keeps lid margins clean and protected.
   Mechanism: Inhibits bacterial protein synthesis.
   Side effects: Blurry vision for a few minutes after use.

9. Ibuprofen (oral, pain/fever)
   Class: NSAID.
   Dose/Time: 200–400 mg by mouth every 6–8 hours with food (max OTC 1,200 mg/day).
   Purpose: Ease pain/tenderness.
   Mechanism: Lowers prostaglandins that drive pain/inflammation.
   Side effects: Stomach upset; avoid with ulcers, kidney disease, late pregnancy.

10. Fluticasone (intranasal spray)
    Class: Topical corticosteroid (in the nose).
    Dose/Time: 1–2 sprays in each nostril once daily.
    Purpose: Calm allergic rhinitis/sinus swelling that worsens tear outflow.
    Mechanism: Reduces local nasal inflammation.
    Side effects: Nose dryness/bleeding; aim slightly outward to protect septum.

If tuberculosis or atypical infections are suspected, your doctor will order tests and use targeted therapy (e.g., full anti-TB regimens). Do not self-treat.

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Dietary, Molecular, and Supportive Supplements

(Evidence for fistula-specific benefit is limited; these support general eye/skin healing and immune health. Always discuss with your clinician, especially if pregnant, on blood thinners, or have kidney/liver disease.)

1. Omega-3 (fish oil or algae DHA/EPA) — Dose: 1–2 g/day combined EPA+DHA. Function: Supports tear film quality and calms surface inflammation. Mechanism: Shifts eicosanoids toward anti-inflammatory pathways.

2. Vitamin A (not high-dose in pregnancy) — Dose: 700–900 µg RAE/day (dietary preferred). Function: Maintains surface epithelium. Mechanism: Supports mucin and epithelial repair.

3. Vitamin C — Dose: 200–500 mg/day. Function: Collagen formation and immune support. Mechanism: Cofactor for collagen enzymes; antioxidant.

4. Zinc — Dose: 8–11 mg/day (do not exceed 40 mg/day long-term). Function: Wound healing and immune function. Mechanism: Enzyme cofactor in tissue repair.

5. Vitamin D3 — Dose: 1,000–2,000 IU/day (adjust to blood levels). Function: Immune modulation. Mechanism: Regulates innate/adaptive responses.

6. Probiotics (lactobacillus/bifidobacterium blends) — Dose: As labeled (often 1–10 billion CFU/day). Function: Gut–immune balance to potentially lower infection risk. Mechanism: Modulates mucosal immunity.

7. Curcumin (turmeric extract with piperine) — Dose: 500–1,000 mg/day standardized curcumin. Function: Systemic anti-inflammatory support. Mechanism: NF-κB pathway moderation.

8. Bromelain (pineapple enzyme) — Dose: 200–400 mg/day away from meals. Function: Helps with swelling and bruising after procedures. Mechanism: Proteolytic, reduces inflammatory mediators.

9. Quercetin — Dose: 500 mg/day. Function: Antioxidant/anti-allergy support (may reduce nasal triggers). Mechanism: Mast-cell stabilization.

10. N-acetylcysteine (NAC) — Dose: 600 mg once or twice daily. Function: Mucolytic/antioxidant; may thin secretions. Mechanism: Restores glutathione; breaks disulfide bonds in mucus.

11. Hyaluronic acid (oral or eye drops—over-the-counter) — Dose: Eye drops as needed; oral as labeled. Function: Surface lubrication, comfort. Mechanism: Water-binding polymer that hydrates tissues.

12. Lactoferrin (supplement or in some eye drops) — Dose: 100–250 mg/day. Function: Antimicrobial support at mucosal surfaces. Mechanism: Binds iron and limits bacterial growth.

13. Collagen peptides — Dose: 5–10 g/day. Function: General tissue repair support. Mechanism: Provides amino acids for collagen synthesis.

14. Silicon (orthosilicic acid) — Dose: As labeled (~5–10 mg/day). Function: Connective tissue health. Mechanism: Supports cross-linking in collagen.

15. Magnesium — Dose: 200–400 mg/day (citrate/glycinate). Function: Overall healing and comfort (sleep, pain modulation). Mechanism: Cofactor in hundreds of enzymatic reactions.

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Regenerative / Stem-Cell–type” Therapies

Straight talk: There is no approved stem-cell drug for lacrimal fistula closure. The cornerstone of cure is surgical correction. Still, some biologic/adjunct therapies may help tissues heal or calm inflammation around surgery. Use only under specialist guidance.

1. Autologous serum eye drops (ASEDs)
   Dose: Often 20–50% serum, 1 drop 4×/day (special pharmacy).
   Function: Improve ocular surface health before/after surgery when the eye surface is very dry/irritated.
   Mechanism: Contains growth factors and vitamins from your own blood; supports epithelial healing.

2. Platelet-rich plasma (PRP) / platelet lysate (specialist use)
   Dose: Protocols vary; sometimes applied to wound edges or compounded as drops.
   Function: Enhance local wound healing in difficult skin areas.
   Mechanism: Platelets release growth factors (PDGF, TGF-β) that signal repair.

3. Amniotic membrane (surgical graft/patch)
   Dose: One-time placement in the operating room.
   Function: Protects tissue and reduces inflammation at the repair site.
   Mechanism: Biological scaffold with anti-inflammatory cytokines.

4. Fibrin glue (biologic adhesive)
   Dose: Applied during surgery.
   Function: Helps close small tracts and seal tissues; may reduce suturing time.
   Mechanism: Mimics the final steps of blood clotting to bind tissues.

5. Topical cyclosporine 0.05–0.1% (immunomodulator eye drops)
   Dose: 1 drop twice daily long-term if ocular surface inflammation is significant.
   Function: Calm chronic surface inflammation that worsens tearing and comfort.
   Mechanism: Reduces T-cell–mediated inflammation in tear glands and conjunctiva.

6. Recombinant growth-factor drops (investigational/limited availability)
   Dose: Only in research or specific compounded settings.
   Function: Attempt to speed epithelial repair.
   Mechanism: Provides exogenous growth factors (e.g., EGF/FGF). Evidence remains limited.

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Key Surgeries

1. External Dacryocystorhinostomy (external DCR) with fistulectomy
   Procedure: Through a small skin incision near the nose, the surgeon creates a new window from the lacrimal sac into the nose, removes the fistula tract, and may place a soft silicone stent for a few weeks.
   Why: Gold-standard when the tear duct is blocked and a fistula has formed. Restores normal drainage and eliminates the shortcut.

2. Endoscopic endonasal DCR (scar-sparing)
   Procedure: Done through the nose with an endoscope; the fistula is excised from outside, and a new internal drainage route is made inside the nose.
   Why: Similar success without an external scar; great when nasal anatomy favors an internal approach.

3. Fistulectomy with primary closure (selected cases)
   Procedure: The small fistula tract is completely excised and the skin closed; sometimes combined with silicone intubation.
   Why: For tiny, well-defined tracts when the main drainage pathway is open or after it’s restored.

4. Canaliculodacryocystorhinostomy (CDCR) with Jones tube
   Procedure: If the canaliculi (small channels near eyelid) are scarred shut, a glass or Pyrex Jones tube is placed to bypass them from the eye to the nose.
   Why: Provides a permanent tear pathway when the front channels are blocked.

5. Dacryocystectomy (DCT)
   Procedure: Surgical removal of the lacrimal sac.
   Why: Used in special situations (e.g., frail elderly with recurrent infections who cannot have DCR, or certain infections like TB) to stop repeated infection, understanding that tearing may persist.

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Practical Preventions

1. Treat styes, blepharitis, and conjunctivitis promptly to limit spread to the tear sac.

2. Manage allergies and sinusitis early to reduce nasal swelling that blocks drainage.

3. Do not rub or pick at the inner eye corner.

4. Keep makeup clean, discard old products, and remove gently every night.

5. Use protective eyewear during dusty work or sports.

6. Keep diabetes well controlled to cut infection risk.

7. Stop smoking/vaping to lower chronic inflammation.

8. Follow post-op instructions exactly if you’ve had any lacrimal procedure.

9. Avoid forceful nose-blowing during infections; be gentle.

10. Seek medical care early for recurring tearing with discharge—don’t wait months.

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When to See a Doctor (red flags)

• Persistent tearing plus yellow/green discharge from a tiny hole on the skin.

• Pain, redness, warmth at the inner corner of the eye.

• Fever, spreading redness, or swelling into the eyelids or cheek.

• Sudden vision changes, severe headache, or double vision.

• A known tear-duct blockage that keeps getting infected.

• A child with constant wetness at the inner corner past a few months of age.

• Any immune-suppressed person with new facial/eye infections.

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What to Eat and What to Avoid

Eat more of (5):

1. Hydrating foods and water (soups, fruits, plain water) to keep secretions thin.

2. Lean proteins (fish, eggs, legumes) to supply amino acids for healing.

3. Colorful vegetables and fruits (vitamin A/C rich: carrots, spinach, citrus) for epithelial repair and collagen.

4. Healthy fats (olive oil, nuts, omega-3 fish) to support anti-inflammatory balance.

5. Fermented foods (yogurt, kefir) for gut–immune support if tolerated.

Limit/Avoid (5):
6) Excess sugar and refined carbs that may impair immune function and feed inflammation.
7) Excess alcohol, which dehydrates and slows healing.
8) Very spicy foods during acute nasal/eye irritation if they trigger tearing/runny nose.
9) Ultra-processed snacks high in salt/additives that can worsen swelling/dehydration.
10) Known personal allergens that flare rhinitis/sinusitis (e.g., certain foods or additives).

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Frequently Asked Questions

1. Will a lacrimal fistula close by itself?
   Usually no in adults. In babies with mild congenital issues, early massage sometimes helps, but long-standing fistulas typically need surgery.

2. Are antibiotics enough to cure it?
   Antibiotics calm infection but do not remove the abnormal tunnel. Surgery provides the cure.

3. Is surgery painful?
   Most people describe mild to moderate discomfort for a few days. Pain medicine and cold/warm compresses help.

4. Will I have a scar?
   External DCR leaves a small scar near the nose that often fades well. An endoscopic DCR leaves no external scar.

5. What is the success rate?
   When chosen correctly, DCR procedures have high success rates for restoring drainage and stopping leakage.

6. How long will the silicone stent stay in?
   Often 4–12 weeks, depending on your surgeon’s preference and healing.

7. Can the fistula come back?
   Recurrence is uncommon but possible if scarring, infection, or underlying disease returns. Good follow-up lowers this risk.

8. Is it dangerous to leave it untreated?
   It can lead to repeated infections, skin irritation, and rarely deeper spread. Getting it treated prevents these problems.

9. Can I wear contact lenses?
   During active infection or heavy discharge, pause contacts. Your doctor will tell you when it’s safe to restart.

10. Will insurance cover the surgery?
    Often yes, as it’s a medical need, not cosmetic. Policies vary—check with your insurer.

11. How do I clean the area at home?
    Use a warm, clean cloth to soften crusts, then gently wipe. Apply a thin layer of petrolatum to protect skin if advised.

12. Do I need imaging?
    Most cases are diagnosed by exam. Imaging is used only when needed to clarify anatomy or rule out other issues.

13. Could it be related to TB or other diseases?
    Sometimes. Your doctor may test for tuberculosis or inflammatory conditions if your history suggests it.

14. How soon can I return to work?
    Many return in a few days, but avoid heavy lifting, dust, or nose blowing per your surgeon’s advice.

15. What if I’m pregnant or breastfeeding?
    Treatment choices and antibiotics must be pregnancy-safe. Always tell your doctor and avoid self-medication.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 10, 2025.

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