Blocked Tear Ducts

Topic Overview

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 occur in about 6 out of 100 newborns.¹ A blocked tear duct that is present at birth (congenital) is called nasolacrimal duct obstruction.

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

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.

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 occurs in the eye's drainage system , you may see redness and swelling (inflammation) 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, cold, and sunlight.

How is a blocked tear duct diagnosed?

A blocked tear duct is diagnosed based on a medical history and a physical exam. Also, tests may be used to measure the amount of tears or to see whether tears are draining normally from the eyes. Other tests can help your doctor find out where the blockage is or how it was caused.

How is it treated?

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

If the duct remains blocked after the baby is 6 months to about 1 year old, a probing procedure may be done. Probing successfully opens the duct for about 90 out of 100 babies who have blocked ducts.¹ Probing is not usually done for adults because it rarely helps.

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

Frequently Asked Questions (FAQs)

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Cause

The most common cause of a blocked tear duct is the failure of the thin tissue, or membrane, that covers the tear duct (lacrimal duct) to open normally into the nasal passage shortly after birth. This disrupts the usual drainage system for tears.

Symptoms usually are not noticed if the blockage resolves on its own before a baby starts producing tears. Normally, tears start forming within the first few days to weeks following birth.

Less common causes of blocked tear ducts in babies can include:

• Infection in the tubes that drain tears from the eyes to the nose (dacryocystitis).
• Blockage of the tear duct at both ends (dacryocystocele).
• Abnormal growth of the nasal bone that puts pressure on a tear duct, closing it off.
• Closed or undeveloped openings in the corners of the eyes (puncta) where tears normally drain into the tear ducts.

Blocked tear ducts in adults

The cause of blocked tear ducts in adults is usually related to another disorder or an injury. For example, a blocked tear duct may result from a thickening of the tear duct lining, abnormal tissue or structures in the nose, or complications of surgery on or around the nose. These types of problems are more likely to occur after age 60.

Symptoms

Babies with blocked tear ducts usually have symptoms after they start producing tears, which can be any time from the first few days to the first few weeks after birth. Symptoms often affect only one eye and usually include:

• Excessive tearing. The eye may appear moist or wet with or without drops flowing down the face (epiphora). Very few babies produce a heavy stream of tears.
• Buildup of a yellowish white substance at the inner corner of the eye. It may also collect on the eyelashes and the lining of the eyelids (conjunctiva). The eyelids may stick together, especially after sleeping.
• Swelling and redness of the eyelids and irritation of the surrounding skin. If a tear duct (lacrimal duct) remains partially or completely blocked, the tear duct sac fills with fluid, and an infection can develop in the drainage system. The infection may cause fever, inflammation (redness and swelling) and tenderness alongside the nose, and mucus or pus in 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, cold, and sunlight.

What Happens

Tear ducts can be fully or partially blocked. The blockage causes tears to back up inside the tear duct system and may cause the tears to overflow onto the face (epiphora). The blockage may also allow infection to develop in the tear ducts as bacteria and other substances collect in the eye. If the tear duct opens by itself, the infection may clear up without treatment.

Most blocked tear ducts are present at birth (congenital) and resolve on their own before a baby is 1 year old.¹ A few babies may need probing to open the ducts. Probing done around age 1 usually works well, and most babies don't need it done again.²

A blocked tear duct by itself usually does not permanently affect a baby's vision or increase the likelihood of having other eye problems.

Infections may develop many times in the affected eye. In rare cases, infection may spread to the eyelids and skin around the eye (periorbital cellulitis). Sometimes a pus-filled sac (dacryocystitis) also forms.

In adults, most blocked tear ducts are caused by infection, structural problems related to injury or surgery, or abnormal growths within the drainage system. Treatment for a blocked tear duct depends on the cause.

• Infections usually clear up with antibiotics. Left untreated, the infection may resolve on its own. But the area may stay swollen (though not tender), and the tear duct can easily become infected again later. If the infection does not clear up on its own and is left untreated, the area around the tear duct can become swollen and tender. The affected eye may become crusty from mucus drainage.
• If structural changes or abnormal growths are causing the tear duct blockage, surgery may be needed to correct the problem.

What Increases Your Risk

Risk factors for a blocked tear duct include:

• Being born early (premature).
• Problems with the structure or functioning of the drainage system for tears (caused by infection, abnormal bone growth, or tumors).
• A family history of blocked tear duct.

When To Call a Doctor

Call your doctor if you or your baby has:

• Swelling and redness of the eyelid, the eyelid lining, the white part of the eye (sclera), or the tissue around the eye (usually just on one side).
• A fever and symptoms of an eye infection, such as eye drainage and swelling, redness, and tenderness alongside the nose. A baby may be fussy and may rub the affected eye often.
• Difficulty seeing or difficulty moving one or both eyes.
• Eye pain or discomfort.
• Excessive tearing in one or both eyes for more than a week.

The following signs may point to other problems with the tear duct. Call your doctor if you have or if your baby has:

• Thick, yellow drainage in the corner or on the surface of the eye.
• Eyelids that are matted by mucus in the morning.
• A bluish swelling inside and below the lower eyelid (dacryocystocele). In babies, this swelling may appear several days after birth. In adults, this may appear during a period of excessive tearing.
• A reddish swelling inside and below the lower eyelid. The eye may have crusty mucus drainage, and the area below the eyelid may be painful.

Call your doctor if you notice excessive tearing in one or both eyes and have:

• Pain, tenderness, or a feeling of pressure in your face and forehead over the area of your sinuses. For more information, see the topic Sinusitis.
• Bloody nasal drainage that lasts for more than a day.

Watchful Waiting

Watchful waiting for 1 to 2 weeks is appropriate in most cases of blocked tear ducts in babies. They usually clear up on their own or with treatment before the baby's first birthday.

Watchful waiting for 1 to 2 weeks also is appropriate for adults with a blocked tear duct without signs of infection. The condition may clear up on its own.

Watchful waiting is not appropriate if you develop excessive tearing in one or both eyes and you:

• Had a recent injury to your face or nose.
• Have signs of infection (such as thick, yellow drainage or crusted mucus in the eye).
• Had recent nasal or sinus surgery.

Who To See

A child or an adult with a blocked tear duct may see:

• A family medicine doctor.
• A nurse practitioner.
• A physician assistant.
• A pediatrician.
• An eye care specialist (ophthalmologist or pediatric ophthalmologist).
• A nose and throat specialist (otolaryngologist).

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

A blocked tear duct is diagnosed based on a medical history, a physical exam, and other testing as needed.

Tests for children and adults may include:

• Fluorescein dye disappearance test. This is often used to determine whether tears are draining normally through the tear ducts from the eye into the nose.
• Culture and sensitivity test. This test helps determine whether infection is present. It may be done if mucus or pus is visible.

Additional tests are sometimes used, although usually only with adults. These tests may include:

• A Schirmer test, used to find out whether the tear glands are producing the normal amount of tears. Special small, soft paper strips are placed in the corner of the person's eyes for about 5 minutes to see how many tears are produced.
• A probe, which involves passing a thin metal wire through the blocked duct to determine where it is blocked. The area is numbed with a local anesthetic before the probe is inserted.
• Imaging tests, such as computed tomography (CT scan) or magnetic resonance imaging (MRI) of the head. Imaging tests may be done to locate the site and structural cause of the tear duct blockage.

Treatment Overview

Most of the time, a blocked tear duct clears up on its own by the time a baby is 1 year old. But you can help prevent infection by keeping the eye clean and massaging the area of the blockage so fluid does not build up in the duct. If signs of infection develop, your baby may need an antibiotic medicine.

If the duct remains blocked after your baby is 6 months to 1 year old, probing may be done to open the duct. In rare cases, babies with blocked tear ducts have a more severe problem that requires more complicated surgery.

Should my baby have a procedure to open a blocked tear duct?

In adults, treatment depends on the cause of the blockage. If the duct is blocked due to a long-term (chronic) infection, antibiotic medicines are used. Surgery for blocked tear ducts may be needed for structural problems of the drainage system (such as from injury or age-related changes) or abnormal growths.

Prevention

Most blocked tear ducts cannot be prevented. The majority of blocked tear ducts are present at birth (congenital) when the thin tissue covering the tear duct does not open normally.

But you can help prevent some conditions that can cause blocked tear ducts, such as:

• Sinus or eye infections. If you have symptoms of these types of infections, see your doctor right away for treatment. For more information, see the topic Sinusitis or Pinkeye.
• Facial injuries. Wear a helmet when you play contact sports such as football.

If your baby has blocked ducts, limit his or her time in the wind, cold, and sunlight. This can help prevent symptoms from getting worse.

Home Treatment

Blocked tear ducts most often occur in babies. If your baby is born with a blocked tear duct, it will usually clear up on its own by 1 year of age.

You can help prevent infection in your or your baby's blocked tear duct by keeping the eye clean and using gentle massage techniques. Wash your hands before and after touching the eye area.

To keep the eye clean:

• Wipe away any drainage around the eye. Moisten a clean cotton ball or washcloth with warm (not hot) water, and gently wipe from the inner (near the nose) to the outer part of the eye. With each wipe, use a new or clean part of the cotton ball or washcloth. Keep a supply of clean cotton balls moistened with water in a sealed plastic bag for use when you are away from home.
• If eyelashes become crusted with drainage, clean them with a moist cotton ball using a gentle, downward motion. If the eyelids become stuck together, place a clean, warm, wet cotton ball over that eye for a few minutes to help loosen the crust.

Massage should only be used under the advice and direction of a doctor. Usually, it is done 2 or 3 times a day for several months.

Medications

Blocked tear ducts prevent the eye's drainage system from working properly and make it prone to infection. Antibiotics are needed if signs of infection develop, such as redness, tenderness, swelling in or around the eye, and mucus that looks like it contains pus.

Some antibiotic solutions and ointments are applied directly to the eye (ophthalmic antibiotics), while some are taken by mouth (systemic antibiotics). They may also be used to try to prevent infection, although they have not been proved effective for this purpose. Antibiotics for more serious or long-term (chronic) infections can help reduce scarring of the drainage system for tears.

To learn the best way to use medicines that you put in your eye, see:

Eye problems: Using eyedrops and eye ointment.

Surgery

Most babies born with a blocked tear duct will not need surgery. But when surgery is needed, probing is usually done. Probing involves passing a thin wire through the blocked tear duct to open it.

Probing may be done in the doctor's office under a local anesthetic (numbing eyedrops) for babies younger than 1 month of age. General anesthesia, which is usually done in an outpatient hospital setting, can be used for older babies. The doctor is able to evaluate your baby's tear duct more thoroughly if general anesthesia is used. Also, if needed, an additional procedure to resolve the blockage often can be performed at the same time and prevent the need for another surgery.

For adults, treatment for a blocked tear duct depends on its cause. Probing is typically not effective with adults, and other surgical procedures are usually used.

Other types of surgery for a blocked tear duct in babies or adults may include breaking a nasal bone, placing a tube in the tear duct, or surgically creating a new tear duct.

Surgery Choices

Surgical options for a blocked tear duct include:

• Probing, which involves passing a thin wire through the blocked tear duct to open it. Probing successfully opens the duct in about 90 out of 100 babies who have blocked ducts.¹

  Should my baby have a probing procedure to open a blocked tear duct?

• Intubation, which involves placing a silicone tube through the tear duct to maintain a passageway for tears to drain into the nostril. This may be done if the duct has excessive scarring or if it is difficult to pass the probe through the duct. Intubation may also be needed if probing is being repeated because a previous probing failed to open the tear duct.
• Infracturing, in which a nasal bone deep within the nose is broken to create an open duct and improve a passageway into the nostril. Infracturing will not permanently affect the size or shape of a baby's nose.
• Balloon dacryocystoplasty, in which a tiny balloon at the end of a probe is used to open the tear duct.

Surgical options that are rarely used for children-and only after the above procedures have failed-include:

• Dacryocystorhinostomy (say "DAK-ree-oh-SIS-toh-ry-NAW-stuh-mee"), which creates a new tear duct canal.
• Endoscopic and laser dacryocystorhinostomy. This procedure creates a new tear duct by using a lighted instrument and passing a flexible tube with a tiny camera on the end (endoscope) into the nostril.

When you talk about surgery options with your child's doctor, use this surgery information form (What is a PDF document?) .

In adults, treatment for a blocked tear duct depends on the cause of the blockage and can include any of the above choices.

What To Think About

About 6 weeks after a surgical treatment, you or your child will most likely visit the doctor for an eye exam and may be tested again with the fluorescein dye disappearance test.

Other Treatment

There is no other treatment for a blocked tear duct at this time.

Other Places To Get Help

Online Resource

Organizations

References

Citations

1. Olitsky SE, et al. (2007). Disorders of the lacrimal system. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., chap. 624, p. 2587. Philadelphia: Saunders Elsevier.

2. Mills MD, Khazaeni LM (2006). Nasolacrimal duct obstruction. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 1098-1099. Philadelphia: Saunders Elsevier.

Other Works Consulted

• Hurwitz JJ (2004). The lacrimal drainage system. In M Yanoff, JS Duker, eds., Ophthalmology, 2nd ed., chap. 98, pp. 761-767. St. Louis: Mosby.

• Soparkar CNS, Patrinely JR (2002). Orbit and lacrimal system. In DH Gold, RA Lewis, eds., Clinical Eye Atlas, chap. 14, pp. 1408-1418. Chicago: American Medical Association.

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