Blocked Tear Duct

Tears drain from the inner corner of the eye through two tiny openings, into a small sac beside the nose and down a duct into the nose. A blocked tear duct, or nasolacrimal duct obstruction, stops that drainage, so tears pool and spill onto the cheek.

In babies it is very common and usually clears without treatment in the first year. In adults the duct narrows with age, inflammation or injury and does not reopen by itself; if it bothers you or causes infections, the lasting fix is a bypass operation called dacryocystorhinostomy (DCR).

Symptoms

• A constantly watery eye, worse outdoors in cold or wind
• Sticky discharge and crusting on the lashes, especially on waking
• Blurred vision from the tear film pooling
• A soft swelling at the inner corner beside the nose
• Mucus or pus coming back from the corner when the swelling is pressed
• Repeated painful infections of the tear sac
• Sore, reddened skin below the eye from wiping

Causes and risk factors

In infants a thin membrane at the lower end of the duct has not yet opened at birth; over 90 percent open by 12 months. In adults the usual cause is gradual age-related narrowing, more common in women. Other causes include chronic sinus or nasal disease, facial fracture, previous nasal surgery, tear sac stones, some chemotherapy drugs and radioactive iodine treatment, and rarely a tumour. A watery eye is not always a blockage: dry eye with reflex watering, a lax lower lid or a turned-in lid produce the same complaint and are treated differently.

How it is diagnosed

• Eye and eyelid examination: Looks at lid position, the drainage openings and the tear film to find non-blockage causes of watering.
• Syringing and probing: Saline is passed through the opening in the lid. If it reaches your throat the duct is open; if it flows back, the level of the block can be judged.
• Dye disappearance test: A drop of fluorescein is watched for 5 minutes; useful in children.
• Nasal endoscopy: Checks the inside of the nose before surgery.
• Dacryocystography or CT: Imaging reserved for trauma, suspected tumour or failed surgery.

Treatment options

• Massage and cleaning in infants: Firm downward pressure over the tear sac several times a day while waiting for the membrane to open.
• Probing under brief general anaesthetic: For babies still watering after about 12 months; successful in most.
• Silicone tube intubation or balloon dilation: For children in whom probing fails, and some adults with partial narrowing.
• External DCR: A new opening is made between the tear sac and the nose through a small skin cut beside the nose. Success is around 90 percent.
• Endoscopic DCR: The same bypass done through the nostril with no skin scar; results are comparable in experienced hands.
• Antibiotics: Treat acute tear sac infection first; surgery follows once it settles.

When it is urgent

A hot, red, very painful swelling between the eye and the nose, with or without fever, is an acute tear sac infection (dacryocystitis) and needs antibiotics the same day. Spreading redness around the eye, a bulging eye, painful eye movements or reduced vision suggest orbital cellulitis, which is an emergency. In a baby, a bluish swelling at the inner corner with breathing difficulty needs urgent paediatric review. Seek this care locally.

Travelling to Türkiye for treatment

Adult DCR is a planned operation of about an hour and suits a visit of 7 to 10 days, which covers the first check and removal of any skin stitches. If a silicone tube is placed, it is removed in clinic after 6 to 12 weeks; this is a quick step that an ophthalmologist or ENT surgeon at home can do. Avoid flying in the first few days because of nosebleed risk. There is little reason to travel for an infant's blocked duct, since most resolve and probing is a short local procedure.

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Frequently Asked Questions