Introduction  

Tears are essential for the eyes. They keep the eyes lubricated and clean and also offer protection from organisms. The white part of the eye and glands inside the eyelids constantly discharge tears into the eye. The tears flow across the eye surface, and when a person blinks, the tears leave the eyes through two tiny holes known as puncta.

The puncta are located in the lower and upper inside corners of the eyelids, close to the nose. The tears then flow through tear ducts that run along the nose. The tear ducts are a drainage system made up of tiny tubes.

The tear ducts are part of the drainage channel that goes from the eyes to the throat. At times, these ducts are narrow or get blocked. It prevents tears from draining out of the eyes. The resulting buildup of fluid makes the eyes watery.

When a section of the tear duct in the bone of the nose blocks, it may contract a serious infection. The infection of the tear sac is called dacryocystitis. Dacryostenosis is a blocked tear duct.

Blocked tear ducts are common among children.

Also Known As

  • Nasolacrimal duct obstructions (NLDO)
  • Blocked nasolacrimal duct
  • Congenital lacrimal duct obstruction
  • Dacryostenosis


Causes and Risk Factors

At times, kids are born with blocked tear ducts. A condition caused by failure of the piece of tissue that covers the ducts, to open up at birth. The ducts may open up on their own within a few months.

On rare occasions, the tear ducts get blocked because the drainage system is undeveloped; it didn’t form properly in the womb.
Among adults, the disorder occurs for many reasons including:

  • The puncta becomes narrow with age
  • Trauma cuts the tear duct
  • Nose injuries cause scar tissue to press on the drainage canal
  • Polyps, small growths, block the duct
  • A nose or eye infection
  • A tumor
  • Certain topical medications
  • Cancer treatment side effect
  • Sinus surgery damage

Risk factors include:

  • Individuals over 50
  • Older women are a higher risk
  • Glaucoma
  • Previous surgery for sinus, eye or eyelid
  • Chronic eye inflammation
  • Previous cancer treatment
     

Signs & Symptoms

Symptoms of eye disorder include:

  • Excess tearing 
  • Watery eyes
  • Redness of the eye white
  • Blurred vision
  • Conjunctivitis 
  • Chronic eye inflammation
  • Recurrent eye infection
  • Painful swelling in the eye corner  
  • Discharge from the eyelids and eye surface

Diagnosis

The eye professional will diagnose blocked tear ducts through a comprehensive exam. These include: 

  • Patient’s history
  • Slit lamp examination
  • Eye imaging tests
  • Tear drainage test
  • Irrigation and probing

The professional also examines the patient’s nose to identify structural disorders that may cause obstruction.
 

Treatment 

Treatment is aimed at unblocking the tear duct.

Medical Treatment

Treatment depends on the cause of the eye disorder. The treatment options are:

  • Watch and wait - Infants and kids with the condition often get better without treatment.
  • Massage - A special massage technique is used to help open the tissue covering the duct.
  • Medication to fight infection - The eye doctor may prescribe eye drops, pills, or antibiotics.
     

Surgical Treatment

Treatment may involve:

  • Dilation, probing and irrigation

This technique is used for infants and kids whose tear ducts aren’t opening on their own. It is also used for adults with narrowing or partially blocked ducts. 

  • Balloon catheter dilation

It is a procedure that opens the tear ducts that are blocked or narrowed by inflammation or scarring.
Intubation or stenting
This procedure uses tiny tubes to open up narrowing and blockages in the tear drainage system.

  • Dacryocystorhinostomy 

 It is a surgical procedure often used to treat blocked tear ducts in adults. It is rarely used in children.

  • Conjunctivodacryocystorhinostomy

In severe cases, the surgeon may have to reconstruct the entire tear drainage system.

Prognosis/Long-term outlook

Blocked tear ducts cause tears to accumulate in the eyes. This becomes a fertile ground for the breeding of bacteria, fungi, and viruses. It increases the risk of chronic eye inflammation, infections, and related complications.

The conjunctiva may become inflamed or infected as a consequence of a blocked tear duct.

Prevention/Follow Up

Some cases can’t be prevented.

Proper treatment of eye infections or inflammation lowers the risk for the disorder.

Wearing protective eyewear helps to prevent injury which may lead to blockage.

It is also vital to replace mascara and eyeliner regularly.

People who wear contact lenses should keep them clean as per the recommendations by the doctor and the manufacturer.