A blocked tear duct occurs when the tear drainage system becomes partially or completely obstructed, and the tear cannot naturally drain, leading to eye irritation.

Blocked tear ducts can affect people at any age, from newborns to adults. In newborns, the condition is common and requires no treatment. It usually improves within a year.  In adults, blocked tear ducts may result from an infection, injury, or rare tumor. Your doctor will select the most appropriate treatment modality, depending on the causes and ages.

Symptoms

• Watery eye
• Red eye
• Eye infection or inflammation
• Swelling at the inner corner of the eye
• Crusty eyelids
• Yellow or green pus in the eye
• Blurry vision

When to see a doctor
When you have a teary eye for 2-3 days, please consult an ophthalmologist. If the blocked tear duct results from a tumor, proper treatment can begin at the earliest.

Causes
Once tears are produced by the lacrimal glands in the upper eyelids, they will flow over the eye surface and into the puncta at the inner corner of the upper and lower eyelids. The puncta connect to canaliculi which drain tears to the lacrimal sac. Tears will flow down the nasolacrimal duct to the nasal cavity, where they are absorbed.

If there is a blockage at any point in the drainage system, your tears become stagnant, leading to eye inflammation and infections. 

Common causes of blocked tear ducts are:

• Congenital blockage due to underdeveloped tear drainage system in newborns
• Age-related narrowing of puncta
• Chronic Infections or inflammation
• Injury and damage near the tear duct
• Tumors
• Long-term use of medications such as eyedrops for glaucoma
• Cancer treatment such as chemotherapy and radiotherapy can cause a blocked tear duct as a side effect

Risk factors

• Older age
• Chronic eye inflammation such as conjunctivitis
• Glaucoma
• History of cancer treatment or eye surgery

Complications

• Eye infections and inflammation are due to the buildup of bacteria, fungi, or viruses.

Prevention

• Avoid rubbing your eyes.
• Wash your hands often.
• Keep your contact lenses clean.
• Avoid sharing eye cosmetics with other people.

Diagnosis

• Medical history taking
• Physical examination, including your eyes and nasal passage
• Tear drainage test: Apply a special dye to the conjunctiva; if most of the dye remains on your eye’s surface after 5 minutes, you may have a blocked tear duct. 
• Probe insertion and irrigation of the lacrimal canal: A probe is inserted into the drainage hole at the puncta to check if there is a blockage.  
• Eye imaging test: Your doctor will flush a special dye on your eyes. An X-ray, CT scan, or MRI can display the blockage in the tear drainage system.

Treatment

• Antibiotic eyedrops or pills to relieve infection over the inner corner of the eye.
• Tear duct massage. A congenital blocked tear duct usually resolves on its own. However, a tear duct massage can help shorten the process by opening the membrane blocking the tear duct in newborns.
• Watch and wait. Your doctor may ask you to wait for 2-3 months to allow self-healing, i.e., the swelling to subside and the tear duct becomes unblocked if your condition results from a facial injury.
• Dilation, probing and flushing. This method is suitable for adults with narrowed puncta. A small probe will dilate the puncta and the tear duct irrigated.
• Stenting or intubation. A thin polyurethane tube will be inserted into the puncta and guided through the nasolacrimal duct. Your doctor will leave a visible tube loop at the puncta for 3 months before removing it.
• Surgery. Dacryocystorhinostomy (DCR) is a surgical procedure for blocked tear ducts. After administering a general or local anesthetic, the tear drainage is cleared and opened, which can be an outpatient procedure.
  • External dacryocystorhinostomy: An incision over the side of your nose near the lacrimal sac exposes the tear drainage system for placement of a stent into a new passageway.  
  • Endoscopic or endonasal dacryocystorhinostomy: A tiny camera inserted through your nose guides small surgical instruments into the tear drainage system. There is no incision or scarring.

Preparation
Before seeing your doctor, you may make a note of

• Your symptoms related or unrelated to the condition.
• Medications and dietary supplements you are taking.
• Eyedrops you are using.
• Questions you would like to ask your doctor.

Sample questions you may want to ask your doctor:

• What causes my symptoms?
• Do I need to undergo any tests?
• What treatment do you recommend? Are there any side effects?
• Will my condition affect my vision?

Sample questions your doctor may ask:

• When is the symptom onset? Associated infection?
• Are your symptoms constant?
• What makes the symptoms better or worse?
• Have you had any previous facial or eyelid surgery or filler injection around the eye?
• Have you ever had radiation to the facial area?
• Do you have any medical conditions such as atopic dermatitis or diabetes?