Blocked Tear Duct (Nasolacrimal Duct Obstruction)

What is a blocked tear duct?

A blocked tear duct is a condition that happens when something keeps tear fluid from draining out of your eyes properly. These blockages slow or stop the flow of tear fluid, causing it to back up in the tear duct system and into your affected eye. The medical term for this condition is “nasolacrimal duct obstruction.”

Your eyes need tear fluid to work properly. Your tear fluid lubricates the surface of your eye and helps your corneas absorb oxygen. Tear fluid also contains immune factors that protect against, or help your eyes recover from, infections.

You can think of your tear system like the gutters and downspouts on a house. The gutters channel water toward the downspout. But a blockage or clog in the downspout can make water back up and spill over the gutters’ edges.

The tear duct system is a series of openings and tubelike structures. The route that tear fluid follows to leave your eyes is:

• The puncta. Each eye has two puncta (the term for just one is “punctum”), one on your upper eyelid and another on the lower. They’re like the drain in a sink or bathtub, letting tear fluid flow out and into the canaliculi.
• The canaliculi. Each punctum drains into a canaliculus (the term for more than one is “canaliculi”). These canaliculi (pronounced “can-al-ICK-yew-lye”) merge and form a single tube before draining into the nasolacrimal ducts.
• The nasolacrimal ducts. The nasolacrimal (pronounced “nay-zo-LACK-rim-al”) ducts are the final tubelike areas that tear fluid travels through. At the bottom of each tear duct, there should be a valve.
• The valve of Hasner. This valve is just an opening that lets tear fluid drain into your nasal passages. Normally, it opens on its own before you’re born. But some babies have a valve that hasn’t opened yet. If it isn’t open, it’s called the membrane of Hasner.

How common are tear duct blockages?

Tear duct blockages are common in very young children, affecting between 6% and 20% of infants. They’re much less common in adults.

What are the symptoms of a blocked tear duct?

The symptoms of a blocked tear duct can include:

• Watery eyes (epiphora).
• Gooey or crusty buildup on your eyelids or in your eyelashes.
• Frequent rubbing of your eye or face around the blocked duct.
• Redness and swelling (from rubbing).
• Blurred vision.

These blockages can also make it easier to develop infections in the tear ducts. Infection symptoms can include:

• Swelling or redness of the tear duct or nearby tissues.
• Fever.
• Fussiness or irritability (especially in babies).
• Eye pain or sinus pressure.
• Redness or irritation of the eyeball, especially the sclera (the white part of your eye).

What causes tear duct blockage?

Tear duct blockages can happen for a few different reasons. Some are congenital, meaning you have them when you’re born. Others develop later in life.

Congenital tear duct blockage

Congenital tear duct obstruction usually happens because a child still has an unbroken membrane where the valve of Hasner should be. That means fluid can build up inside the lacrimal duct. Over time, the accumulated tear fluid can cause the duct to expand. It can also lead to an infection of the tear duct or other parts of the tear system.

Other causes of tear duct blockage

Tear duct blockages can also happen because of other conditions or be more likely to happen under certain circumstances. These are more likely to happen higher up in your tear duct system (or in parts that aren’t technically tear ducts, but they connect to the ducts).

Examples include:

• Infections. Chronic infections of your eyes or surrounding areas can contribute to scar tissue buildup. Sometimes, that scar tissue can cause narrowing and form a blockage.
• Injuries. Trauma to your face, eye or nose can cause swelling and tissue changes around your tear system. Swelling or tissue changes affecting any part of the system can cause or contribute to a blockage.
• Narrow tear ducts (dacryostenosis). Sometimes, your tear ducts are narrow when you’re born, or they get narrower during your lifetime. Either can cause or contribute to a blockage.
• Aging. Your tear ducts and surrounding areas can change and narrow as you age.
• Tumors or growths. This includes benign (harmless) growths or cancerous tumors (but these are rare). Growths called mucoceles can also cause blockages in your tear ducts. These are small, mucus-filled pockets that can develop in the neighboring sinuses (the ethmoid sinuses on either side of your nose are right next to the tear system).
• Tear stones (dacryoliths). These can form when tear fluid collects and hardens. If these are big enough, they can block a tear duct.

What are the risk factors for a blocked tear duct?

Babies have the highest chance of developing a blocked tear duct. Blockages usually happen because the membrane at the bottom of the tear nasolacrimal duct doesn’t open and become the valve of Hasner.

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

• Chronic eye inflammation, such as uveitis.
• Glaucoma.
• Eye or sinus surgery.
• Previous cancer treatment, such as radiation therapy or chemotherapy.

What are the complications of a blocked tear duct?

A blocked tear duct is just the kind of place where bacteria find it easy to grow, so bacterial infections or abscesses are the main possible complications of a blocked tear duct. The infections can also affect your sinuses, eyes and other nearby tissues. That’s why treating and keeping the infection from spreading is very important.

How is a blocked tear duct diagnosed?

An eye care specialist or healthcare provider can usually diagnose a blocked tear duct based on your symptoms and by inspecting or feeling around your eye and tear duct. They’ll also ask you about your symptoms. If your baby might have a blocked tear duct, they can also check for this or do certain tests to look for a blockage.

One simple test they can do is called the “dye disappearance test.” To do it, a provider adds a drop of a special dye called fluorescein to your eye. Fluorescein glows under a blue light, so a provider can put a single drop of it into saline and then put the saline into your eye. After five minutes, they can check with a black light and see if any dye remains. If it’s still there, that can indicate you have a total or partial tear duct blockage.

Other tests are also possible, especially if your healthcare provider suspects that a blocked tear duct might be happening because of another condition or issue. The tests they recommend depend on your symptoms, circumstances and what condition they suspect could be the cause.

Because so many factors can play a role, it’s best to talk with them about the testing options. They can provide information that’s specific and relevant to your particular situation.

How is a blocked tear duct treated, and is there a cure?

A blocked tear duct is very treatable. But the treatments are different depending on the age of the person who has it and other factors. This condition can get better without treatment, especially in babies, but it’s better to try and treat it to avoid complications like infections.

Some treatments, like antibiotics, are possible no matter your age. These are most likely if you have an infection related to a blocked tear duct, and they can come in topical or eye drop forms. Other medications may also help. Your eye care specialist is the best person to tell you more about these options.

The main treatment for babies and infants with a blocked tear duct is a special massage technique that you can do at home. If your child or a child you care for has it, their pediatrician can show you exactly how to do this. This massage technique is usually all it takes to make the membrane pop open and become a valve.

If the blockage doesn’t get better with massage by the time a child has their first birthday, it’s more likely they’ll need a different treatment approach. Massaging also isn’t likely to help adults, so other treatments are usually necessary.

Some of these treatments may need to happen under sedation or anesthesia. Your (or your child’s) eye care specialist or provider can tell you if and why they recommend sedation or anesthesia.

Dilation, probing and irrigation

One of the simpler approaches to treating a blocked tear duct is a three-step technique called dilation, probing and irrigation. This technique can help babies if massage isn’t helpful. It’s also a likely first treatment for older children and adults.

The steps of the technique work like so:

• Dilation. To do this first step, an eye care specialist will dilate (widen) the puncta and other tear system structures on the affected side. That makes room for what will happen in the next step.
• Probing. For this step, an eye care specialist will use the special tool(s) to probe (explore) the blocked part of the tear system. That helps them find the cause of the blockage and remove it, if possible.
• Irrigation. This final step involves pushing saline fluid through the tear duct to make sure it’s clear and wide enough.

Balloon dilation

In cases where simple dilation, probing and irrigation aren’t enough, a more advanced type of dilation may be necessary. When this is the case, your child’s eye care specialist will use a tool with a tiny balloon attachment on it. They’ll inflate the balloon slowly and gently in narrowed areas. Pushing like this from the inside can often widen the duct and resolve the issue.

Stenting or intubation

In some cases, balloon dilation may not be enough to widen a narrow tear duct permanently. In these cases, inserting a tube or stent might be the best approach. These devices provide a sturdy, hollow framework that can hold the duct open and still let tear fluid flow through.

Surgical procedures

In some cases, surgery may be the best choice to fix a blocked tear duct or reroute tear fluid around it. Two main surgeries are possible:

• Dacryocystorhinostomy (DCR). For this procedure, a surgeon creates a bypass route for tear fluid to flow through. The new route will completely bypass the existing blockage.
• Conjunctivodacryocystorhinostomy (CDCR). This procedure reconstructs your entire tear duct system.

The advantages, disadvantages and possible complications of the surgical procedures vary widely. The type of blockage you have, where it is and other factors can all play a role. Your surgeon or eye care specialist is the best source of information about what you can expect.

Can tear duct blockages be prevented?

Tear duct blockages happen for reasons that are unpredictable, outside your control or that you can’t see happening. That means there’s no way to prevent them.

There are a few things you can do to reduce the odds of an issue that could lead to a blockage, though. These mainly revolve around avoiding infections, including the following precautions:

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

What can I expect if I have (or my child has) a tear duct blockage?

Tear duct blockages usually have a positive outlook, depending on why they happen. Tear duct blockages aren’t dangerous on their own. But some of the causes can be. And blockages can lead to dangerous infections, so getting a blockage diagnosed and treated is important.

Congenital blockages have an excellent outlook. About 70% of children with these blockages get better by the time they’re 6 months old, and 90% get better by their first birthday. While blockages can go away spontaneously, the massage technique speeds up that process and reduces the chance of an infection or other issues. Congenital blockages also usually don’t cause problems later in life.

In adults, the outlook is generally good, depending on the cause. Most causes, especially injury-related causes, respond well to treatment, and many approaches can help. Your eye care specialist can tell you more about which treatments are most likely to help, the outcome you can expect, and what you can do to improve that outcome.

How do I take care of myself?

If you have (or a child you care for has) a tear duct blockage, an eye care specialist can guide you on treating and managing it. You shouldn’t try to self-diagnose or self-treat a tear duct blockage. If you think you have symptoms of a blockage, you should schedule an appointment with an eye care specialist and see them as soon as possible.

When should I see my healthcare provider, or when should I seek care?

If you have a tear duct blockage, your eye care specialist will give you treatment instructions and guidance. You can also ask them about the signs and symptoms that mean you need to call them or seek medical care more quickly.

What questions should I ask my doctor?

You may want to ask your eye care specialist or healthcare provider the following:

• What’s 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?