What Is a Blocked Tear Duct?

A blocked tear duct is a clog in the eye’s tear drainage system. When this happens, your tears can’t drain like they should. Instead, the tears well up on your eye, causing watery, irritated eyes and possibly leading to a tear duct infection.

In this article, we’ll discuss how a blocked tear duct, also known as a nasolacrimal duct obstruction or dacryostenosis, can happen. We’ll also go over some signs of a tear duct blockage, and what to do if you think you have one (or two).

What Causes Blocked Tear Ducts?

Having a clogged tear duct can be bothersome. But what causes blocked tear ducts in the first place? Learning how tears typically drain from the eyes can help us understand how a clogged tear duct can occur.

Let’s take a look at how the eye’s tear drainage system works.

How the Tear Drainage System Works

Your tears lubricate and protect your eyes. Tear glands (also called lacrimal glands) are situated in and around your upper eyelids and produce your tears.

From the tear glands, tears take a bit of a journey. A blockage can happen at any point along the way, impeding your tears’ travels. But if your drainage system is healthy, it works like this:

First, tears flow from the tear glands down your eyes’ surface. They then drain into the tear ducts (or puncta) located inside the corners of your eyes. From there, tears flow through small lacrimal canals (called canaliculi) to lacrimal sacs at the inner corners of your eyes before draining through the side of the nose.

At this point, if a lot of tears are flowing, such as when you’re crying, you may get a runny nose. Usually, the tears evaporate or get reabsorbed.

When the tear duct gets blocked, tears can’t travel and drain properly. Instead, they back up, often resulting in watery eyes or other possible symptoms (which we’ll go over in a bit).

Causes of a Clogged Tear Duct

Several circumstances can lead to a clogged tear duct. Let’s take a look at some of the common causes of a blocked tear duct in adults and children:

• Congenital blocked tear duct: Between 6 and 20% of infants are born with a blocked tear duct.
• Eye infection: Eye infections, like conjunctivitis (pink eye) or infections from contact lenses, can lead to swollen tear ducts that get blocked. And if bacteria get into the tear drainage system, an infected tear duct (called dacryocystitis) can occur.
• Nasal infection: Chronic nasal infections like sinusitis can cause scars that block the eye’s tear duct system. 
• Atypical facial development: People with disorders affecting the development of the skull and face, like Down syndrome, might be more likely to develop blocked tear ducts.
• Punctal stenosis (narrow lacrimal canals): Punctal stenosis is a narrowing of the lacrimal canaliculi. These canals carry tears from the tear ducts to the lacrimal sacs. People around age 40 and older, especially those with blepharitis, may be more likely to get punctal stenosis.
• Nose or eye injury: Trauma to the eye or nose, like a broken nose, can produce swelling and scars that can result in plugged tear ducts.
• Allergies: For some people, eye allergies can cause polyps, or small bumps, to form in the nasal lining. The polyps then push on the tear duct, blocking it. Or the nasal lining can swell, which can obstruct tear ducts.
• Medical treatments: Some medical treatments, such as certain glaucoma eye drops or cancer treatments, can cause tear ducts to swell and become blocked.

Blocked Tear Duct Symptoms

Symptoms of a blocked tear duct can become more pronounced after a sinus infection or a cold. And you might notice the symptoms more in direct sunlight or when you’re outside in low temperatures or windy weather.

It’s important to note that some blocked tear duct symptoms can be signs of another eye condition or infection. To truly determine what the problem is, it’s best to see an optometrist or ophthalmologist for an exam.

Symptoms of a blocked tear duct or infected tear duct might include:

• Watery eyes (excessive tearing)
• Swelling, redness, or pain around the nose or eye or at the inside corner of the eye
• Redness of the whites of your eyes
• Mucus discharge from the eye that might form a crust
• Recurring eye infections
• Blurry vision
• Blood-tinged tears
• Fever

Blocked Tear Duct Treatment

So, how do you unclog a tear duct? The treatment for a blocked tear duct depends on the cause. In some cases, blocked ducts may require surgery. Typically, treatment can correct blocked tear ducts.

Your eye doctor might suggest one or more of these blocked tear duct treatments:

• Watch and wait: A blocked tear duct sometimes needs time to fix itself. For example, a newborn’s congenital clogged eye duct usually resolves on its own in a few months when the baby’s tear drainage system matures.
• Massage: For babies with blocked tear ducts, your eye doctor might show you a gentle massage technique to try and get the ducts open and flowing.
• Antibiotics: If your eye doctor suspects an infection, they may prescribe antibiotics. These could be antibiotic eye drops or oral medication.
• Dilating, probing, and flushing: A health care provider uses a small probe to dilate (enlarge) clogged or small tear duct openings, which may then be flushed out with saline. For children, this can be done under general anesthesia.
• Balloon catheter dilation: Under general or local anesthesia, a catheter containing a deflated balloon is inserted into the blocked tear duct. The balloon is repeatedly inflated and deflated to open up the tear drainage passageway.
• Stenting (intubation): A stent, or thin tube, is threaded through the tear drainage system from the tear duct into the nose. This is typically done under general anesthesia.
• Dacryocystorhinostomy: Often called DCR to make it less of a mouthful, this surgery creates a new pathway between the tear ducts and the nose for tears to drain. DCR is typically performed under general anesthesia.

Clear the Way for Your Best Eye Health

Your tears are an important part of your eye health. They keep your eyes lubricated so you don’t get dry eyes, they protect eyes from irritation and infection, and they even play a part in keeping your vision clear.

Getting regular comprehensive eye exams will help maintain the health of your tear drainage system and the rest of your eyes. And as always, see an eye doctor whenever you experience vision problems or eye discomfort, or suspect you have an eye issue.