What is a blocked tear duct?

Tears normally drain from the eye through small tubes called tear ducts that stretch from the eye into the nose. A blocked tear duct occurs when the opening of the duct that normally allows tears to drain from the eyes is obstructed or fails to open properly. If a tear duct remains blocked, the tear duct sac fills with fluid and may become swollen and inflamed, and sometimes infected.

Blocked tear ducts are thought to occur in about 30% of newborns. However, noticeable symptoms are present in only 2% to 4% of newborns.¹ A blocked tear duct that is present at birth (congenital) is called nasolacrimal duct obstruction or dacryostenosis.

Blocked tear ducts are uncommon in adulthood. They mostly occur in older adults and are usually the result of an injury or related to another disorder.

What causes a blocked tear duct?

In babies, the most common cause of a blocked tear duct is the failure of the thin tissue at the end of the tear duct to open normally at or near birth.

Other less common causes of blocked tear ducts in children include:

• Infections.
• Abnormal growth of the nasal bone that puts pressure on a tear duct and closes it off.
• Closed or undeveloped openings in the corners of the eyes (puncta) where tears drain into the tear ducts.

In adults, tear ducts may become blocked as a result of a thickening of the tear duct lining, nasal or sinus problems, injuries to the bone and tissues around the eyes (such as the cheekbones), infections, or abnormal growths such as tumors.

What are the symptoms?

Usually, the first symptom of a blocked tear duct is excessive tearing, ranging from a wet appearance of the eye to tears running down the cheek. Babies who have blocked tear ducts usually have symptoms within the first few days to the first few weeks after birth. If infection develops in the eye's drainage system for tears, inflammation that includes redness and swelling may develop around the eye or nose. Also, yellow mucus can build up in the corner of the eye, and the eyelids may stick together. In severe cases, infection can spread to the eyelids and the area around the eye.

The symptoms of a blocked tear duct may get worse after an upper respiratory infection, such as a cold or sinus infection. Also, symptoms may be more noticeable after exposure to wind and cold.

How is a blocked tear duct diagnosed?

A blocked tear duct is diagnosed based on a medical history and a physical exam. Additional tests may be used to measure tear production, to see whether tears are draining normally from the eyes into the nose to determine where a blockage is located, or to help determine the cause of the blockage.

How is it treated?

Babies born with blocked tear ducts usually do not need treatment. More than 90% of blocked ducts clear up on their own by 1 year of age.² However home treatment measures to keep the eye clean and to help drain the duct can help prevent infection. Antibiotics usually are needed if signs of infection develop, such as redness, swelling, or yellowish discharge.

If the duct remains blocked after the baby is 6 months to about 1 year old, a simple probing procedure may be done. Probing successfully opens the duct in more than 90% of babies.² Probing is not usually done in adults because it is rarely effective.

Other treatments for a blocked tear duct include antibiotics for a long-term infection or surgery for structural problems or abnormal growths.