Blocked tear duct

When you have a blocked tear duct, your tears can't drain normally, leaving you with a watery, irritated eye. The condition is caused by a partial or complete obstruction in the tear drainage system.

A blocked tear duct is common in newborns. The condition usually gets better without any treatment during the first year of life. In adults a blocked tear duct may be due to an injury, an infection or rarely, a tumor.

A blocked tear duct is almost always correctable. Treatment depends on the cause of the blockage and the age of the affected person.

Symptoms of a blocked tear duct include:

• Excessive tearing
• Redness of the white part of the eye
• Recurrent eye infection or inflammation, known as pink eye
• Painful swelling near the inside corner of the eye
• Crusting of the eyelids
• Mucus or pus discharge from the lids and surface of the eye
• Blurred vision

See your health care provider if you tear constantly for several days or if your eye is repeatedly or continually infected. A blocked tear duct may be caused by a tumor pressing on the tear drainage system. Early identification of the tumor can give you more treatment options.

Blocked tear ducts can happen at any age, from birth to adulthood. Causes include:

• Congenital blockage. Many infants are born with a blocked tear duct. The tear drainage system may not be fully developed or there may be a duct abnormality. Often a thin tissue membrane remains over the opening that empties into the nose, called the nasolacrimal duct.
• Age-related changes. As you age, the tiny openings that drain tears, called puncta, may get narrower, causing blockage.
• Infection or inflammation. Long-standing infection or inflammation of your eyes, tear drainage system or nose can cause your tear ducts to become blocked.
• Injury or trauma. An injury to your face can cause bone damage or scarring near the drainage system, affecting the typical flow of tears through the ducts. Even small particles of dirt or loose skin cells lodged in the duct can cause blockage.
• Tumor. A tumor in the nose or anywhere along the tear drainage system can cause blockage.
• Eye drops. Rarely, long-term use of certain medicines, such as eye drops used to treat glaucoma, can cause a blocked tear duct.
• Cancer treatments. A blocked tear duct is a possible side effect of chemotherapy medicine and radiation treatment for cancer.

How the tear drainage system works

The lacrimal glands produce most of your tears. These glands are located inside the upper lids above each eye. Typically, tears flow from the lacrimal glands over the surface of your eye. Tears drain into openings, called puncta, on the inside corners of your upper and lower eyelids.

The puncta lead to small canals called canaliculi. Canaliculi move tears to a sac to a reservoir on the side of the nose called the lacrimal sac. From there tears travel down the nasolacrimal duct and drain into your nose. Once in the nose, tears are reabsorbed.

A blockage can occur at any point in the tear drainage system, from the puncta to your nose. When that happens, your tears don't drain properly, giving you watery eyes and increasing your risk of eye infections and inflammation.

Certain factors increase your risk of developing a blocked tear duct:

• Age. Older adults are at increased risk of developing blocked tear ducts due to age-related changes.
• Chronic eye inflammation. If your eyes are continually irritated, red and inflamed, you're at higher risk of developing a blocked tear duct.
• Previous surgery. Previous eye, eyelid, nasal or sinus surgery may have caused some scarring of the duct system, possibly resulting in a blocked tear duct later.
• Glaucoma. Anti-glaucoma medicines are often used topically on the eye. If you've used these or other topical eye medicines, you're at higher risk of developing a blocked tear duct.
• Previous cancer treatment. If you've had radiation or chemotherapy to treat cancer, particularly if the radiation was focused on your face or head, you're at higher risk of developing a blocked tear duct.

Because your tears aren't draining the way they should, the tears that remain in the drainage system become stagnant. This promotes growth of bacteria, viruses and fungi, which can lead to frequent eye infections and inflammation.

Any part of the tear drainage system, including the clear membrane over your eye surface known as the conjunctiva, can become infected or inflamed because of a blocked tear duct.

To reduce your risk of developing a blocked tear duct later in life, get prompt treatment of eye inflammation or infections. Follow these tips to avoid eye infections in the first place:

• Wash your hands thoroughly and often.
• Try not to rub your eyes.
• Replace your eyeliner and mascara regularly. Never share these cosmetics with others.
• If you wear contact lenses, keep them clean according to recommendations provided by the manufacturer and your eye care specialist.