Tear ducts are a drainage system that carries tears away from the eyes. When these ducts become swollen, it indicates an underlying issue affecting their normal function, leading to discomfort and various noticeable symptoms.
How Tear Ducts Function
The tear system continuously produces and drains tears to maintain eye health. Tears are primarily produced by the lacrimal glands, located in the upper, outer corner of each eye. These tears spread across the eye’s surface with each blink, lubricating the eye, flushing out foreign materials, and providing a protective layer.
Tears drain through tiny openings called puncta, found on the inner corners of the upper and lower eyelids. From the puncta, tears enter small tubes called canaliculi, which lead to the lacrimal sac, situated near the bridge of the nose. The lacrimal sac then empties into the nasolacrimal duct, a tube that carries tears into the nasal cavity, explaining why crying can cause a runny nose.
Primary Causes of Swollen Tear Ducts
Swelling of the tear ducts can arise from several distinct problems, often involving either a physical blockage or an infectious process.
A common reason is a blocked tear duct, known as nasolacrimal duct obstruction. In infants, this blockage is often congenital, where a membrane did not fully open at birth, though it frequently resolves spontaneously within the first year.
In adults, blockages can be acquired due to age-related narrowing, scar tissue from chronic infections, or inflammation. Injury to the face or eye, such as a broken nose, can also obstruct the tear drainage system. Small particles or debris can sometimes lodge within the ducts, impeding tear flow.
Infections are a common cause of swollen tear ducts. Dacryocystitis is an infection of the lacrimal sac, often occurring when a blocked duct prevents tears from draining, creating a stagnant environment for bacteria. This can manifest acutely with sudden, severe symptoms or chronically with milder but persistent issues.
Beyond blockages and infections, inflammation of the lacrimal gland, known as dacryoadenitis, can cause swelling. This affects the gland above the eye, not the drainage ducts near the nose. Dacryoadenitis can be triggered by infections (viral or bacterial) or systemic conditions like autoimmune diseases such as sarcoidosis. Abnormal growths or tumors can also compress the tear ducts or lacrimal glands, leading to swelling and impaired drainage. Other medical conditions, such as nasal polyps or a deviated septum, can indirectly contribute by affecting the nasal passages into which the ducts drain.
Identifying Symptoms
When tear ducts become swollen, several signs and symptoms emerge. A visible swelling or lump may appear near the inner corner of the eye, close to the nose, or in the upper outer part of the eyelid, depending on the affected area. This area often feels tender and appears red.
Excessive tearing, known as epiphora, is common because tears cannot drain properly and overflow onto the cheek. There might also be a discharge of pus or mucus, which can be yellow or green, sometimes leading to crusting of the eyelashes. Individuals may experience discomfort or pain around the eye, and the discharge can temporarily blur vision. A fever may also accompany the swelling, particularly if an infection is present.
When to Consult a Doctor
Consult a doctor if symptoms of a swollen tear duct persist or worsen. Seek medical attention for persistent swelling, redness, or pain around the eye that does not improve. Signs of infection, such as fever, pus, or rapidly worsening pain, warrant prompt medical evaluation.
Any changes in vision, including blurriness or double vision, should also prompt a visit to a doctor. If the swelling is accompanied by a general feeling of illness or affects an infant and does not resolve within the first few months, medical assessment is recommended.
Management and Treatment
Treatment for swollen tear ducts depends on the cause, ranging from home care to medical procedures. For mild cases or discomfort, warm compresses can help loosen blockages and promote drainage. Gentle massage near the inner corner of the eye, especially for infants with congenital blockages, can also encourage the duct to open. Maintaining good eye hygiene can help prevent secondary infections.
When a bacterial infection is present, antibiotics are prescribed. These can be oral, topical eye drops or ointments, with intravenous antibiotics for severe infections.
For persistent blockages not resolving with conservative measures, various procedures may be considered. Nasolacrimal duct probing involves inserting a thin wire to clear obstruction, common for infants. Balloon dilation uses a small balloon to widen the passageway. For chronic or recurrent blockages, especially in adults, dacryocystorhinostomy (DCR) creates a new drainage route from the lacrimal sac directly into the nasal cavity, bypassing obstruction. Temporary silicone tubes may also be inserted to keep ducts open during healing.