A clogged tear duct occurs when the drainage system for tears becomes partially or completely blocked. This blockage often leads to persistent tearing, crusting around the eyelids, and temporary blurred vision.
Medically referred to as dacryostenosis, this condition is frequently seen in infants due to an incomplete development of the tear duct at birth. In adults, it is often acquired through the aging process, chronic inflammation, recurring infections, or structural anatomical changes.
Treatment is managed by an ophthalmologist who will evaluate the severity of the obstruction. For infants, gentle massage is typically the first line of defense, while adults may require medicated eye drops or minor surgical procedures to restore proper drainage.
Main symptoms
The primary signs that your tear duct may be obstructed include:
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Persistent, excessive watering of the eye
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An accumulation of tears gathering in the inner corner of the eye
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Visible discharge or pus in the affected eye
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Crusting on the eyelashes, particularly noticeable upon waking
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Blurred vision caused by the excess fluid
In some cases, you may also experience redness, tenderness, or swelling near the inner corner of the eye. Persistent obstructions can sometimes lead to recurring bouts of conjunctivitis.
Clogged tear duct in newborns
This condition is common in newborns, typically because the nasolacrimal duct has not yet fully opened. It results in eyes that remain constantly watery, often leading to crusty eyelashes after a period of sleep.
Occasionally, the discharge may appear thick or whitish in color. While it is generally not painful, the skin surrounding the inner corner of the eye can sometimes become irritated or slightly red.
Most infant cases resolve naturally within the first few months of life. It is important to keep the eye area clean and consult a pediatrician or ophthalmologist if you notice signs of infection, such as pus, significant redness, or swelling.
Clogged tear duct in older adults
In older adults, a clogged tear duct is usually an acquired condition rather than a congenital one. It often stems from age-related narrowing of the duct, chronic inflammation, or previous trauma. This can result in persistent irritation and visible redness of the skin around the eye.
How it is diagnosed
An ophthalmologist diagnoses a clogged tear duct by reviewing your symptoms and performing a physical eye exam. During the visit, the doctor may perform a dye disappearance test by placing a drop of fluorescein in your eye. If the dye remains after five minutes, it suggests the drainage system is not clearing properly.
To confirm the diagnosis or identify the precise site of the blockage, your doctor may order imaging tests. These can include an MRI, a CT scan, or a dacryocystography, which uses a contrast agent to visualize the tear duct system.
Potential causes
The primary factors leading to a clogged tear duct include:
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Congenital malformation present at birth
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Natural narrowing of the duct due to aging
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Facial trauma, such as a blow to the nose or orbital bones
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Recurring infections or dacryocystitis
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Nasal issues, including a deviated septum, nasal polyps, or chronic sinus inflammation
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Chemotherapy side effects
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Long-term use of specific eye drops for glaucoma
A blockage can also be mechanical, such as the formation of dacryoliths (small tear stones) that obstruct the duct. Less commonly, tumors can compress the system, which disrupts the normal flow of tears.
Treatment options
Your ophthalmologist will determine the best course of action based on the cause and severity of the blockage.
1. Massage
Manual massage is often the first approach for infants. Gently massaging the inner corner of the eye four to five times a day can help clear the obstruction. If the blockage persists past the child’s first birthday, a minor surgical procedure may be required. For adults, massage may be recommended following facial trauma to assist with drainage while healing occurs.
2. Medicated eye drops
If the eye is inflamed or infected, your doctor may prescribe antibiotic drops, such as tobramycin or ciprofloxacin, to resolve the infection. If inflammation is the primary concern, mild topical corticosteroids may be used to reduce redness and swelling.
3. Tear duct probing
During a probing procedure, a thin, sterile instrument is inserted into the tear duct to manually clear the blockage. In infants, this is performed under general anesthesia. In adults, it is usually done with local anesthesia, and the doctor may also dilate and flush the duct to ensure it is clear.
4. Stent placement
An ophthalmologist may place a thin, temporary tube called a stent into the tear duct. This device remains in place for approximately three months to keep the pathway open while it heals. The stent is surgically removed after this period.
5. Surgery
A dacryocystorhinostomy (DCR) is a surgical option for adults dealing with chronic or recurring infections. The procedure is typically performed by an ophthalmologist through a small incision near the side of the nose, which is designed to minimize visible scarring. Laser-assisted DCR is also available as a less invasive alternative, using a fiber-optic probe to create a new drainage opening.
6. Dacryoendoscopy
This diagnostic and treatment procedure uses a microendoscope to provide a direct view inside the tear duct. It allows the physician to identify the exact nature of the blockage (whether it is caused by stones, mucus, or narrowing) and often allows for the removal of the obstruction during the same visit.