A blocked tear duct (dacryostenosis) is a common condition where the eye’s drainage system is obstructed, preventing tears from flowing normally into the nasal cavity. The primary symptom is epiphora, or excessive tearing, where tears spill over the eyelid and onto the cheek. This blockage often leads to a persistent watery eye, sometimes accompanied by a sticky discharge or crusting around the eyelids. This issue is particularly prevalent in infants, with nearly 6% of newborns experiencing symptoms.
Understanding the Causes of Tear Duct Blockage
The cause of an obstruction is typically categorized by age, which dictates the likely treatment path. In infants, the blockage is usually congenital, present from birth because the nasolacrimal duct did not fully open. The most frequent reason is a thin membrane at the bottom of the duct, the Valve of Hasner, which fails to rupture before or shortly after birth. This causes tears to back up into the lacrimal sac and overflow onto the eye’s surface.
In adults, blockages are generally acquired and arise from other factors. These can include age-related narrowing of the drainage passages, chronic inflammation (like conjunctivitis), or scarring from trauma or previous surgeries. Narrowing of the puncta, the tiny openings on the inner corner of the eyelids that initiate tear drainage, can also contribute. Additionally, certain systemic diseases or treatments, such as radiation or chemotherapy, may cause tissue changes that lead to obstruction.
Step-by-Step Home Clearing Techniques
For infants with congenital dacryostenosis, the initial and most effective home treatment is a specific type of massage, often called the Crigler maneuver. This technique increases hydrostatic pressure within the tear sac to force open the unruptured Valve of Hasner. Before beginning, hands must be thoroughly cleaned to prevent introducing bacteria to the eye area.
To perform the massage, an index finger is placed on the side of the nose over the lacrimal sac, located in the inner corner of the eye near the nasal bridge. Firm but gentle pressure is applied inward, followed by a downward rolling motion along the side of the nose. This pressure helps build up fluid in the sac, and the downward stroke directs that pressure toward the blockage.
This action should be repeated in a series of five to ten strokes during each session. It is recommended to perform the massage three to five times per day until the condition resolves. Seeing a small amount of mucus or tears exit the puncta during the massage is a sign that the technique is generating sufficient pressure.
Supportive care helps manage the overflow and prevent secondary infection. Excess discharge or crusting should be gently cleaned away using a clean cloth or cotton ball moistened with warm water. Applying a warm compress to the area for a few minutes can also help soften any accumulated discharge. This conservative approach resolves the issue in a large percentage of infants, often before their first birthday.
Recognizing Warning Signs and Infection
While home massage is often successful, it is important to recognize signs that indicate the blockage may be infected or require professional intervention. A buildup of stagnant tears and mucus in the lacrimal sac can lead to an acute infection called dacryocystitis. This condition requires prompt medical attention and cannot be resolved with massage alone.
Signs of dacryocystitis include redness, swelling, or tenderness localized to the inner corner of the eye near the nose. A fever may accompany the swelling, and a thick, yellow, or green discharge may be present. Pressure over the area may cause a reflux of purulent material from the puncta.
If home care is being used for an infant, a consultation with an eye specialist is typically advised if the tearing and discharge persist beyond six to twelve months of age, even without signs of acute infection. For adults, a prolonged period of persistent tearing, especially if it interferes with daily life or vision, warrants a full medical evaluation.
Professional Medical and Surgical Treatments
When conservative measures fail, a doctor will confirm the diagnosis, often using a fluorescein dye disappearance test to observe how quickly tears drain. If the blockage persists past the first year of life in children, the first-line medical intervention is nasolacrimal duct probing. This involves passing a thin, blunt metal wire through the tear duct opening to puncture the persistent membrane.
If probing is unsuccessful, or for more complex pediatric blockages, a balloon catheter dilation may be performed using a small, inflatable balloon to widen the duct. For chronic blockages in adults, or persistent failure after probing in children, the surgical procedure of choice is Dacryocystorhinostomy (DCR).
A DCR creates a bypass, rerouting the tear drainage system by making a new opening that connects the lacrimal sac directly to the nasal cavity. This can be performed externally through a small incision on the side of the nose or endoscopically through the nose, which avoids an external scar. A temporary silicone stent is often placed during the procedure to keep the newly created passage open while the tissues heal, typically remaining in place for several weeks or months.