The lacrimal system is a network of glands and ducts responsible for tear production, distribution, and drainage. Tears are produced in the lacrimal glands, lubricate the eye’s surface, and then drain through small openings called puncta near the inner corner. These openings lead into the nasolacrimal duct, or tear duct, which empties into the nasal cavity. A blockage at any point in this drainage system prevents tears from exiting normally, causing them to back up onto the ocular surface. This obstruction disrupts the natural flow, leading to a variety of noticeable symptoms.
Key Symptoms for Identification
The most common sign of a tear duct blockage is a persistent, watery eye, technically known as epiphora. Tears that cannot drain properly spill over the eyelid and run down the cheek, even when a person is not crying. This constant overflow is often more pronounced when exposed to wind, cold weather, or sunlight, as these conditions stimulate tear production.
Another indicator is discharge or crusting around the eyelids and eyelashes. Stagnant tears create a moist, warm environment that traps debris and promotes bacterial growth. This results in a sticky, whitish, or yellowish discharge that dries overnight, leading to significant crusting upon waking. The inability of tears to flush away foreign material also increases the likelihood of recurrent eye infections, such as conjunctivitis.
A more severe symptom is dacryocystitis, an infection and inflammation of the lacrimal sac. This manifests as painful swelling and tenderness located precisely at the inner corner of the eye, adjacent to the nose. The area may appear red and feel warm to the touch due to the trapped fluid and infection. In some instances, the pressure from the buildup of mucus and pus within the blocked sac can be expressed by gently pressing on this swollen area.
Other signs include redness of the white part of the eye, caused by irritation from constant moisture and potential infection. Some individuals may also experience temporary blurred vision because the excess tear film distorts the surface of the cornea. These symptoms, especially when persistent in one eye, point toward an issue with the tear drainage pathway.
Why Tear Ducts Become Blocked
Tear ducts can become blocked for several distinct reasons, depending significantly on a person’s age. For infants, the most common cause is a congenital blockage, where a thin membrane covering the end of the nasolacrimal duct fails to open before birth. This particular blockage, often referred to as the membrane of Hasner, is present in about 5% of newborns and frequently resolves on its own within the first year of life as the drainage system matures.
In adults, blockages are more often acquired and can result from physical changes or external factors. Chronic inflammation or infection in the eye, nose, or sinuses can lead to the formation of scar tissue that narrows the duct’s interior. Conditions like chronic sinusitis, for example, cause swelling and tissue damage that may eventually compromise the tear drainage route.
Age-related changes are a contributor to acquired blockages, often involving the narrowing of the puncta, the tiny drain openings on the eyelids. This narrowing, known as stenosis, slows the drainage process, causing tears to back up over time. Trauma to the face, such as a broken nose, can also cause damage or scarring to the bone and soft tissues surrounding the duct, creating a physical obstruction. A blockage may also be caused by a tumor or polyp growing inside the nose or tear drainage system, pressing on the duct and inhibiting flow.
Treatment and When to Consult a Doctor
Initial management for a suspected blocked tear duct often involves simple, at-home measures. For infants with a congenital blockage, a gentle technique called lacrimal sac massage is frequently recommended. This involves applying light pressure near the inner corner of the eye to help force fluid through the membrane and open the obstruction. Warm compresses can also be applied to soothe the area and help loosen any crusted discharge around the eyelids.
For adults, or for infants whose blockage has not resolved by one year of age, professional intervention is usually necessary. An eye care specialist may first attempt probing, where a thin wire is passed through the punctum and down the duct to clear the blockage. If the blockage is due to narrowing, a balloon catheter dilation may be performed, where a balloon is inserted and inflated to widen the passage.
In cases where less invasive methods fail or the blockage is structural, a surgical procedure called dacryocystorhinostomy (DCR) may be recommended. DCR creates a new pathway for tears to drain directly from the lacrimal sac into the nasal cavity, bypassing the blocked duct entirely.
It is advisable to consult a healthcare professional if tearing is constant for several days, if eye infections happen frequently, or if the eye is consistently irritated. Immediate medical attention is necessary if symptoms include a fever, acute and increasing pain, or any changes to vision, as these can signal a worsening infection requiring prompt antibiotic treatment.