Definition

Nasolacrimal duct blockage refers to a condition where the tear duct becomes obstructed, preventing normal tear drainage. This issue is the most frequently encountered disorder within the tear production and drainage system.

Tears are generated by the lacrimal or tear glands, which are positioned in the upper eyelid. Under normal conditions, tears travel from these glands to small openings, known as puncta, situated in the inner corners of both the upper and lower eyelids. These puncta serve as entry points to tiny channels that transport tears into a sac located on the side of the nose, called the lacrimal sac. From there, the tears continue their journey through a passage known as the nasolacrimal duct, directing them toward the nasal cavity. Once inside the nose, the tears are naturally absorbed by the body.

An obstruction can develop anywhere along this tear drainage route, from the puncta to the nasal passage. When this occurs, tears fail to drain efficiently, resulting in persistent watery eyes and elevating the likelihood of eye infections and inflammation.

Tear duct obstructions are frequently observed in newborns. It is estimated that approximately 6-20% of infants experience symptoms related to a blocked tear duct. Signs of this condition typically emerge within the first week to month after birth, often presenting as excessive tear production and eye discharge. In most cases, this condition resolves on its own without requiring medical intervention within the first year of life.

In adults, an obstruction in the tear duct can stem from various causes, including trauma, infections, or abnormal tissue growth. Fortunately, blocked tear ducts in adults can generally be treated. The method of treatment depends on the underlying cause of the obstruction as well as the age of the individual affected.

Causes

Blocked tear ducts can occur at any age, from newborns to adults, due to several factors:

• Congenital abnormalities. Many babies are born with blocked tear ducts. The tear drainage system may not be fully developed, or there may be duct abnormalities, often accompanied by a thin membrane covering the opening of the tube leading to the nose.
• Increasing age. As we age, the puncta (tear duct openings) can narrow, causing blockages.
• Infection or inflammation. Chronic infections or inflammation of the eyes, tear drainage system, or nose can cause blocked tear ducts.
• Injury or trauma. Facial injuries can damage bones or create scar tissue near the drainage system, interfering with tear flow. Even small particles of loose dirt or skin cells entering the ducts can cause blockages.
• Tumor. Tumors in the nose or other parts of the tear drainage system can cause blockages.
• Eye drops. Long-term use of certain medications, such as glaucoma eye drops, can rarely cause blocked tear ducts.
• Cancer treatment. Blocked tear ducts can occur as a side effect of chemotherapy and radiation therapy, especially if the radiation is directed at the face or head.

Risk Factor

Certain factors can increase the risk of blocked tear ducts:

• Age. The risk of blocked tear ducts increases with age.
• Chronic eye inflammation. Constant eye irritation, redness, and inflammation increase the risk of blocked tear ducts.
• History of eye surgery. Eye, eyelid, nose, or sinus surgery can cause scar tissue in the duct system, leading to blockages.
• Glaucoma. Long-term use of anti-glaucoma eye drops or other eye drops increases the risk of blocked tear ducts.
• History of cancer treatment. Radiation or chemotherapy for cancer, particularly focused on the face or head, increases the risk of blocked tear ducts.

Symptoms

Signs and symptoms of blocked tear ducts include:

• Excessive tears and eye discharge
• Redness of the eyes
• Recurrent eye infections or inflammation
• Painful swelling near the inner corner of the eye
• Crusts on the eyelids
• Mucus or pus discharge from the eyelids and eye surface
• Blurred vision

Diagnosis

To diagnose blocked tear ducts, your doctor will begin with an interview about your symptoms and conduct a physical and eye examination. A nasal examination may also be performed to check for nasal structural issues that could cause obstruction. If a blocked tear duct is suspected, the doctor will recommend specific tests to locate the blockage. Diagnostic tests for blocked tear ducts include:

• Tear drainage test. This test measures the flow rate of your tears. A special dye is placed on the surface of both eyes. If most of the dye remains on the eye surface after five minutes, it indicates a blockage in the tear ducts.
• Irrigation and probing. The doctor will flush saline solution through your tear drainage system to check its functionality. Alternatively, a small probe may be inserted into the tear duct through the puncta to detect blockages. This procedure can sometimes help clear the blockage.
• Eye imaging examinations. Contrast dye is introduced into your tear drainage system through the puncta, followed by X-ray, CT, or MRI scans to identify the blockage's location and cause.

Management

Treatment for blocked tear ducts varies based on the underlying cause. Multiple treatments may be needed to address the problem. Treatment options include:

• Infection medications

If an infection is suspected, the doctor will prescribe antibiotic eye drops or pills.

• Observation or eye massage

Newborns with blocked tear ducts often recover without any treatments needed as their drainage system will mature within a few months. If a thin membrane is covering the duct opening, special massage techniques can help open it.

For blocked tear ducts caused by facial injuries, eye observation may be recommended to see if the condition improves as the injury heals and swelling decreases.

• Dilation, probing, and flushing

For infants, this procedure is performed under general anesthesia. The doctor enlarges the puncta opening and inserts a thin probe through the puncta into the tear drainage system.

For adults with narrowed puncta, the puncta is widened with a small probe, followed by irrigation of the tear duct. This simple outpatient procedure is often a temporary solution.

• Stent placement or intubation

Conducted under general anesthesia, a thin silicone or polyurethane tube is inserted through one or both puncta, passing through the tear drainage system into the nose. A small visible loop of the tube remains at the eye corner and is left in place for about three months. Inflammation due to the stent is a potential complication.

• Balloon catheter dilation

If other treatments fail or the tear duct blockage recurs, this procedure may be used. It is effective for infants, toddlers, and adults with partial blockages. Under general anesthesia, a catheter with a deflated balloon at the tip is inserted into the blocked duct. The balloon is then inflated and deflated several times to clear the blockage.

• Dacryocystorhinostomy

This surgery creates a new tear drainage pathway into the nose and places a stent to keep it open during healing. It can be performed under general or local anesthesia as an outpatient procedure. Post-surgery, a nasal spray and eye drops are used to prevent infection and reduce inflammation. The stent is removed after 6-12 weeks.

If a tumor is causing the blockage, treatment will focus on the tumor. Surgery may be performed to remove it, or other therapies may be recommended to shrink it.

Complications

Blocked tear ducts can lead to tears pooling in the tear drainage system due to the disruption of normal tear flow. This stagnant tear pool can become a breeding ground for bacteria, viruses, or fungi, causing recurrent eye infections and inflammation. Any part of the tear drainage system, including the conjunctiva (the clear membrane on the surface of the eye), can become infected or inflamed due to blocked tear ducts.

Prevention

To reduce the risk of blocked tear ducts and associated eye infections:

• Have your eyes checked immediately if you experience eye inflammation or infection.
• Wash hands thoroughly and frequently.
• Avoid rubbing your eyes.
• Do not share eye products, such as eye drops or cosmetics, with others.
• If you wear contact lenses, maintain cleanliness according to the manufacturer's and your doctor's recommendations.

When to See a Doctor?

Consult your doctor if you experience persistent watery eyes for several days or recurrent eye infections. Blocked tear ducts can sometimes be caused by a tumor pressing on the tear drainage system. Early identification of tumors can provide more treatment options and potentially better outcomes.

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