Blocked tear duct

Definition

A blocked tear duct is a partial or complete blockage in the pathway that carries tears away from the surface of the eye into the nose.

Alternative Names

Dacryostenosis; Blocked nasolacrimal duct; Nasolacrimal duct obstruction (NLDO)

Causes, incidence, and risk factors

Tears are constantly being made to help protect the surface of your eye. They drain into a tear duct through a very small opening in the corner of your eye, near your nose. This opening is called the nasolacrimal duct. If this duct is blocked, the tears will build up and overflow onto the cheek, even when you are not crying.

In children, the duct may not be completely developed at birth. It may be closed or covered by a thin film, causing a partial blockage.

In adults, the duct can be damaged by infection, injury, or a tumor.

Symptoms

The symptom is increased tearing, which overflows onto the face or cheek. In babies, this tearing becomes noticeable during the first 2 - 3 weeks after birth.

Sometimes, the tears may appear to be thicker. The tears may dry and become crusty.

If there is pus in the eyes or the eyelids get stuck together, your baby may have an eye infection called conjunctivitis.

Signs and tests

Most of the time, the health care provider will not need to do any tests.

Tests that may be done include:

• Eye exam
• Special eye stain (fluorescein) to see how tears drain
• X-ray studies to examine the tear duct (rarely done)

Treatment

Carefully clean the eyelids with a warm, wet washcloth. Be careful not to use the same part of the washcloth more than once.

Some doctors suggest gently massaging the area 2 - 3 times a day. Using a clean finger, rub the area from the inside corner of the eye toward the nose. This may help to open the tear duct.

If an eye infection develops, your health care provider may recommend that you use eye drops or ointment.

A blocked tear duct that does not improve may need to be opened by a probing procedure. This may require anesthesia. Rarely, a small tube or stent needs to be placed in the tear duct to keep it open.

In adults, the cause of the blockage must be treated. This may re-open the duct if there is not much damage. Surgery to reconstruct the passageway may be needed to re-establish normal tear drainage, and stop the overflow onto the cheek.

Support Groups

Expectations (prognosis)

Most of the time, a blocked tear duct will go away on its own before the child is 1 year old. If it does not clear on its own, the outcome is still likely to be good with treatment.

The outlook for a blocked tear duct in adults varies depending on the cause.

Complications

Tear duct blockage may increase the risk of eye infections.

Calling your health care provider

See your health care provider if you have tear overflow onto the cheek, because a tumor is one of the possible causes. Earlier treatment is more successful, and may be life-saving.

Prevention

Many cases cannot be prevented. Properly treating nasal infections and conjunctivitis may reduce the risk. Safety measures may reduce the risk of trauma that can cause a blockage.

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References

Olitsky SE, Hug D, Smith LP. Disorders of the lacrimal system. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 624.