Blocked Tear Duct

Overview, Signs and Symptoms of an Obstruction

The lacrimal gland secretes tears to lubricate and maintain the ocular surface. Tears enter the tear duct, which drains from the eye into the nose. When there is an obstruction or blockage, tears spill over the eyelids and run down the face instead. This blockage can also create a mucous discharge, which leads to irritation, red eyes, and infections. Excessive tearing can result in skin changes on the lower eyelids from excess salt and water.

Congenital Nasolacrimal Duct Obstruction

Babies are commonly born with obstructed tear ducts; in fact, roughly 6% of all children are born before their tear ducts are open. The medical term for this is nasolacrimal duct obstruction (NLDO). Blockages can be simple obstructions, congenital fistulas, acute dacryocystitis, and/or congenital dacryocele/mucocele.

Tears within the blocked ducts can become stagnant and then infected. This causes a collection of pus, a yellowish, sticky discharge from the eye that signifies a bacterial infection. Pus is actually a store of white blood cells and debris created to fight off infection. It can glue the eye shut. Antibiotics can help symptomatically, but they do not remove the blockage. While most blockages resolve within the first few months of life, surgery to remove the obstruction and open the passageway might be necessary.

Medical Treatment of Congenital Obstructions

At Idaho Eyelid and Facial Plastic Surgery, we have seen many infants, children, and adults with blocked tear ducts. While many of these obstructions resolve on their own, treatment depends on both the type of blockage/obstruction and the age of the patient. Remedies include: observing the blockage and hoping for a spontaneous correction, massaging to create a pressure wave that can open the blockage, prescribing antibiotics, probing the blockage, and surgery. The surgery is called a dacryocystorhinostomy (DCR), which is performed to create a new tear drain to bypass the blockage. The steps in this surgery involve making a small incision around the nasal passage, creating a tear drain from the tear duct to the nose, and placing a temporary tube in the new tear drain to keep it open while it heals.