Blocked Tear Duct (Nasolacrimal Duct Obstruction)

Overview

What is a blocked tear duct?

The tears that moisturize your eye drain through a tiny opening in the corner of your eye. The liquid enters your nose, where your body absorbs and disposes of it.

A blocked tear duct is a full or partial obstruction (blockage) in the nasal (nose) passageways that drain tears. If you have a blocked tear duct, your eyes may be itchy, irritated and watery. Another name for a blocked tear duct is nasolacrimal duct obstruction. Lacrimal refers to tears.

How does the tear system work?

Typically, your tear system keeps your eyes slightly wet but not too watery. Your tear system has three parts:

  • Lacrimal glands create tears.
  • Puncta are small openings at your eye corner where tears flow out.
  • Nasolacrimal ducts connect to the puncta and drain the rest of your tear fluid into the nose.

What are the tear ducts?

Tear ducts are another name for the nasolacrimal ducts. They form at the corner of your eye nearest your nose. They run underneath the skin and connect to your facial bones and nose.

How does a clogged tear duct affect my body?

When you have a clogged tear duct, tears can’t drain into the nose through the nasolacrimal ducts. Instead, your tears stay in your eye. The result is uncomfortable, watery eyes.

What is a partial tear duct blockage?

Sometimes, a narrow tear duct (dacryostenosis) can lead to a partial tear duct blockage. When you have a partial blockage, your tears may build up and not drain properly. This tear buildup can lead to infection. If you have a partial blockage, your provider will likely use similar treatments as a full blockage.

Who might get a blocked tear duct?

Blocked tear ducts are common in newborns. Usually, a blocked tear duct in a baby goes away without treatment.

Adults are more likely to develop a tear duct blockage if they have:

Symptoms and Causes

What causes a blocked tear duct?

Blocked tear ducts can happen to anyone of any age. Causes of blocked tear ducts include:

  • Age: As you get older, your puncta may naturally narrow.
  • Congenital blockages: Some babies are born with tear ducts that are narrow or not fully formed (dacryostenosis).
  • Infection: Chronic sinus infections or eye infections can lead to blockage.
  • Injury: Any eye injury near the tear ducts, even a scrape from tiny dirt particles, can cause a blockage.
  • Tumors: A tumor anywhere near the tear ducts, such as in the nose, can cause blocked tear ducts.

What are the symptoms of a blocked tear duct in adults?

The most common sign of a blocked tear duct is watery eyes or excessive tearing. You may also experience:

  • Blurred vision.
  • Crusting around the eyelids.
  • Drainage, such as mucus or pus around the eyes.
  • Redness in the white part of your eye.
  • Swelling near your eye’s inner corner.

What are the symptoms of a blocked tear duct in infants?

Babies don’t start making tears until they are a few weeks old. You may not notice a blocked tear duct in a newborn right away. As babies get older, blocked tear duct symptoms might include:

  • Redness around the eye, usually from your baby rubbing the eye.
  • Tears draining down the baby’s cheek instead of out of the eye corner.
  • Tears pooling near the corner of the eye but not draining.
  • Yellowish discharge or mucus in the baby’s eye.

Diagnosis and Tests

What tests can help diagnose a blocked tear duct?

To diagnose a blocked tear duct, your healthcare provider asks about your symptoms. Your provider may also use tests that examine the eyes and nose, including:

  • Tear drainage test: Your provider places one drop of dye on each eye. If the dye does not drain from your eye, it could mean you have a blocked tear duct.
  • Eye imaging: Your provider puts a special, safe dye in your eye. This dye travels through your tear drainage system. It shows up on an X-ray, CT scan or MRI to help your provider find the blockage.
  • Irrigation and probing: Irrigation uses a fluid to clean out your tear ducts. Your provider may insert a small instrument through the corner of your eye to find the obstruction.

Management and Treatment

What is the treatment for a blocked tear duct in adults?

Blocked tear duct treatment depends on the cause. For example, if you have a tumor, your treatment focuses on removing or shrinking the tumor.

Additional treatment options may include:

  • Medications: If an eye infection caused the blockage, your provider may prescribe oral antibiotics or medicated eyedrops.
  • Dilation, probing and flushing: Your provider enlarges the opening at the corner of your eye. Then, using a small probe, your provider sends fluid through the tear duct. Usually, this “flushing” removes the blockage at least temporarily.
  • Stenting: Your provider places a small, hollow tube (stent) through the puncta and into the tear duct. The tube allows tears to drain properly. The tubes stay in place for about three months. You will see a small portion of the tube out of the corner of your eye.
  • Balloon catheter dilation: Your provider places a small, deflated balloon into the tear duct. Then your provider inflates the balloon a few times to clear the blockage. You are usually under general anesthesia (medication to help you remain asleep) for this procedure.
  • Snip punctoplasty: Your provider makes two or three small incisions around your puncta. These incisions create a larger tear duct opening. Snip punctoplasty is a common treatment for partial blockages.

What is dacryocystorhinostomy for blocked tear ducts?

If less-invasive options don’t bring relief, your provider may recommend surgery. Providers usually use dacryocystorhinostomy (DCR). This procedure creates a new route to drain tears into your nose.

On the day of surgery, you receive anesthesia to help you stay calm and numb during the operation. During the procedure, your surgeon:

  1. Creates a connection between your lacrimal sac and nose. The surgeon may use small incisions or place tools through the nose.
  2. Places stents (small, hollow tubes) to hold open the new route as it heals.

A dacryocystorhinostomy is usually an outpatient surgery, meaning you can go home the same day. Typically, your surgeon removes the stents after three to four months.

What is the treatment for a blocked tear duct in babies?

Often, a blocked tear duct in a newborn resolves without treatment. In the first few months of life, the baby’s tear ducts may mature and get rid of the blockage.

Sometimes, a baby still has a small piece of tissue blocking the flow of tears inside the nose. Your baby’s provider may teach you a special eyelid massage technique. This massage helps open the tissue so tears can drain as they should.

If a watch-and-wait approach does not work, providers may use dilation and flushing, balloon catheters or stents. These treatments work the same way in babies as they do in adults. However, providers use general anesthesia to keep babies still and calm during the procedure.

Prevention

How can I prevent a blocked tear duct?

The best way to avoid a blocked tear duct is to get care right away for eye problems, such as inflammation, infection or injury. To prevent eye inflammation or infections:

  • Avoid rubbing or excessively touching your eyes.
  • Avoid sharing eye products, such as eyedrops or cosmetics.
  • Clean contact lenses according to your eye doctor’s instructions.
  • Replace cosmetics, such as mascara, eyeliner or eyeshadow, every three to six months.
  • Wash your hands frequently and thoroughly.

Outlook / Prognosis

What is the outlook for blocked tear ducts?

If the blocked tear duct is because of an injury, it usually clears up on its own once the injury heals. Blocked tear ducts in babies often open up in time or with home care.

People who receive blocked tear duct treatment typically have an excellent outlook. In particular, dacryocystorhinostomy has around a 90% success rate. Most people don’t have any further symptoms after treatment.

Living With

What else should I ask my healthcare provider?

You may also want to ask your healthcare provider:

  • What is the most likely cause of a blocked tear duct?
  • What treatments do you recommend?
  • Are there any treatment side effects?
  • Is the tear duct blockage related to another medical condition?
  • How can I prevent the blockage from returning?

A note from Cleveland Clinic

Blocked tear ducts occur when your nasolacrimal passages cannot drain tears as they should. If you have a blocked tear duct, you may have watery, irritated eyes. Some newborns have blocked tear ducts that often heal without treatment. In adults, treatment may include flushing out the tear duct or surgery. Treatment completely relieves symptoms for most people.

Last reviewed by a Cleveland Clinic medical professional on 05/27/2021.

References

  • American Academy of Ophthalmology EyeWiki. Dacryorhinostomy. (https://eyewiki.aao.org/Dacryocystorhinostomy) Accessed 5/27/2021.
  • American Academy of Ophthalmology. What Is a Blocked Tear Duct? (https://www.aao.org/eye-health/diseases/what-is-blocked-tear-duct) Accessed 5/27/2021.
  • American Society of Ophthalmic Plastic & Reconstructive Surgery. Blocked Tear Ducts – Adults Dacryocystorhinostomy (https://www.asoprs.org/dcr) (DCR). Accessed 5/27/2021.
  • HealthDirect. Blocked tear duct. (https://www.healthdirect.gov.au/blocked-tear-duct) Accessed 5/27/2021.
  • Merck Manual (Professional Version). Tearing (Epiphora). (https://www.merckmanuals.com/professional/eye-disorders/symptoms-of-ophthalmologic-disorders/tearing) Accessed 5/27/2021.

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