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Blocked Tear Ducts- Causes, Symptoms, Management, and Prevention

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Blocked tear ducts may occur because of partial or complete blockage of nasal passages; most heal independently. Read the article to know more.

Written byDr. Anjali

Medically reviewed byDr. Shikha Gupta

Published At October 17, 2022
Reviewed AtJuly 5, 2024

Introduction

Blocked tear ducts are also called nasolacrimal duct obstructions. This obstruction occurs in Hasner's valve at the distal end of the duct. As a result, eyes may become irritated, itchy, and watery. These ducts form at the corners of the eye and connect the bones of the face and the nose. When there is obstruction, tears cannot drain from the eyes; instead, tears stay in the eyes and make the eyes watery, leading to infection.

Congenital nasolacrimal duct obstruction is seen in five percent of infants. There is no genetic predisposition. Almost 90 % of nasolacrimal duct obstruction is resolved within the first year of life. When conservative methods fail to remove the obstruction, a surgical procedure is performed to relieve the obstruction.

What Are the Causes of Blocked Tear Ducts?

  • Older age can lead to narrowing of the puncta (minute opening is present on the margins of eyelids at the lateral extremity and helps to collect tears).

  • Congenital blockage.

  • Narrow tear ducts.

  • Severe eye infections or sinus infections.

  • Tumors or polyps (small polyps) in the nose.

  • Nasal allergies.

  • An injury in the eye.

  • History of chemotherapy or radiotherapy.

  • Uveitis is inflammation of the eye.

  • Patients with Down syndrome have nasal deformities.

  • Glaucoma (a condition that damages the optic nerve).

  • Conjunctivitis (pink eye, when conjunctiva gets inflamed).

  • Viral infections.

  • Deviated nasal septum.

  • Trauma cuts the drainage ducts.

What Are the Symptoms of Blocked Tear Ducts?

  • Loss of visual acuity (the ability of eyes to distinguish shapes and details).

  • Watery, itchy eyes.

  • Epiphora (excessive tears).

  • Fever.

  • Redness.

  • Mucous or pus discharge.

  • Crusting around the eyes.

  • Swelling near the inner corner of the eye.

  • Dacryocystitis occurs due to nasolacrimal duct obstruction and is characterized by painful, red, swollen nodules over the tear duct. It is a medical emergency that requires antibiotics and hospitalization.

  • Dacryocele is a bluish nodule over the tear duct seen in infants. Nasal endoscopy with cyst removal is done to manage the condition.

What Are the Risk Factors?

  • Sex: Females are more prone to nasolacrimal duct obstruction.

  • Smoking: Tobacco smoking can also predispose to blocked tear ducts.

  • Swimming: Swimming in chlorinated water.

How Can We Diagnose a Blocked Tear Duct?

  • Tear Drainage Test: If tears do not flow from your eyes, you may have blocked tear ducts.

  • Fluorescein Dye Test: The fluorescein dye disappears, which can help confirm the diagnosis of obstruction of the lacrimal duct. It is useful when the unilateral eye is involved.

  • Eye Imaging: Computed tomography (CT) scan, magnetic resonance imaging (MRI), and X-ray can be done to find the location and cause of blocked tear ducts.

  • Probing: An instrument can be used to probe the blocked tear duct.

How to Manage Blocked Tear Ducts?

  • Massage: Firm pressure can be used downward; built hydrostatic pressure causes mucus reflux and tears through the puncta.

  • Hygiene: Cleaning of the eyelids is done to prevent blocked tear ducts.

  • Antibiotics: Oral antibiotics or eye drops can be given in case of an eye infection.

  • Dilation, Probing, and Flushing: These procedures can be performed to remove the obstruction. A probe is used to dilate the puncta, and then the tear duct is flushed. This procedure provides temporary relief.

  • Stenting: Stenting is performed under general anesthesia. The hollow tube is placed through the puncta into the tear duct. This duct helps drain the tears properly and is placed for around three months. Complications can arise because of hollow tubes placed through the puncta.

  • Balloon Catheter Dilation: A catheter is inserted into the tear duct. A pump inflates the tube, then the doctor deflates or inflates the balloon repeatedly to widen the duct.

  • Dacryocystorhinostomy: Outpatient surgery is done to bypass the blocked tear duct. Connection is made between the lacrimal sac and the nasal cavity, and a stent is placed for three to four months to open the new route to drain tears into your nose. Dacryocystorhinostomy relieves tear duct obstruction. There are a few side effects, such as infection, scars, stuffy noses, and bruises.

Surgery can be performed in the following ways.

  1. External: A small cut is made on the side of the nose, which is closed with stitches.

  2. Internal: The camera and instrument are inserted through the opening of the nose. This type of surgery causes less pain and scars.

  3. Snip Punctoplasty: Incisions are given on the puncta to create a larger tear duct opening. This procedure is used for partial obstruction.

How to Prevent a Blocked Tear Duct?

  • Avoid sharing cosmetics or eye drops.

  • Avoid rubbing your eyes.

  • Wash your hands thoroughly.

  • Replace your cosmetics after every three months.

  • Use clean contact lenses.

  • In mild cases, warm compresses are recommended.

  • Proper treatment of nasal infections and conjunctivitis may reduce the risk.

What Is the Differential Diagnosis?

Differential diagnosis includes:

  • Conjunctivitis (inflammation of the conjunctiva).

  • Corneal abrasion (rubbing of the cornea).

  • Uveitis hemangiomas (non-cancerous overgrowth of blood vessels in the retina).

  • Dermoids (growth of normal tissue).

  • Nasal gliomas (rare congenital midline tumors).

  • Infantile glaucoma (glaucoma seen in the first few years of life).

What Are the Complications of Blocked Tear Ducts?

As the tears are not draining correctly, they become stagnant in the drainage system. This can induce the growth of bacteria, fungi, and viruses. This can cause regular eye infections and inflammation.

Some risk factors are

  • Age.

  • Chronic eye inflammation and infection.

  • Glaucoma (a group of eye conditions that can affect the vision caused by nerve damage).

  • Prior surgery.

  • Cancer treatment.

Conclusion

Nasolacrimal duct obstruction occurs when nasal passages cannot drain liquid properly from the eyes. Clogged tear ducts make the eyes uncomfortable, causing itchiness in the eyes. When the drainage system gets blocked, it causes pain and decreased visual acuity, increasing the risk of infection. In addition, it may cause watery or irritated eyes. Nasolacrimal duct obstruction causes mucus discharge with systemic illnesses such as fever and malaise. Typically, obstruction presents in the first weeks or months of life. Blocked tear ducts are seen mainly in infants and get cured independently. However, it usually requires treatment in adults, with an almost 90 % success rate.

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Frequently Asked Questions

If a blocked tear duct is not treated, it can lead to irritation and infections in the eye. Additionally, it can result in pain and may affect vision. Watery eyes, mucous discharge, and fever can also occur if the blocked tear duct is left untreated.
In babies, blocked tear ducts are very common and they resolve on their own. However, in adults, it does not resolve on its own and typically requires appropriate treatment, including surgery. The success rate of this treatment is approximately 90%.
 
Intubation is the procedure used for unblocking tear ducts. In this procedure, the doctor performs the surgery by inserting a thin tube into the puncta, or holes, in the corners of the patient's eyes. The tube enters the interior of the nose through each tear duct. The entire process lasts roughly an hour. To clear the ducts and allow tears to escape, the tubes are left in place for three to six months.
 
No, blocked tear ducts result in watery eyes because tears cannot drain properly if tear ducts are blocked. The tear glands above the eye normally release tears, which then spread across the surface of the eyeball and drain into ducts in the corner. However, if the ducts get blocked, tears will accumulate and cause watering of the eye. Numerous factors, including infections, injuries, and even aging, might contribute to the issue.
An eye specialist or ophthalmologist is specialized in diagnosing and treating eye diseases. Therefore, they should be contacted if someone shows blocked tear duct symptoms such as watery, itchy eyes. Additionally, the eye doctor could occasionally recommend an expert in ophthalmic plastic surgery for the eye if needed in a particular case.
A person having a blocked tear duct will experience the following symptoms:
 
Watery eyes.
Itchy eyes.
Excessive tear production.
Redness in eyes.
Pain in eyes.
Pus discharge, swelling, and crusting.
Impairment in identifying shapes and details (visual acuity).
Occurrence of nodule over the tear duct.
Yes, a blocked eye duct can cause blurry vision. A person affected by a blocked eye duct will have a significant decline in visual acuity (the ability of eyes to distinguish shape and details), resulting in impaired vision.
 
A blocked tear duct is caused by infection or inflammation of the eyes. Applying makeup to the eyes, especially in the inner corner of the eyes, sometimes can result in inflammation of the eyes, which can block the tear duct. This usually happens when a makeup product irritates someone’s eyes or when an infected eyeliner brush is used. 
A blocked tear duct affects the eye's drainage system, resulting in its impairment. If the tear duct is obstructed, the fluid will build up and may cause eye pressure to rise. This increased pressure can damage the vision
There are several ways to get rid of nasal blockage, which is listed below.
 
Inhalation of steam.
Saline rinses.
Neti pots.
Nasal decongestants.
Humidifiers.
 
Nasal congestion usually goes away in a few days, but if it persists for a week or longer, it could indicate an infection. Nasal polyps, middle ear infections, and sinusitis can all result from untreated nasal congestion.
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Dr. Shikha Gupta from iCliniq
Dr. Shikha Gupta

Ophthalmology (Eye Care)

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