How the Tear Drainage System Works

Tears are produced by the lacrimal gland and spread across the eye surface with each blink. They then drain through two small openings (puncta) at the inner corners of the upper and lower eyelids, into the canaliculi, through the lacrimal sac, and down the nasolacrimal duct into the nose. When a blockage occurs anywhere along this pathway, tears overflow onto the cheek instead of draining normally.

Symptoms of Obstruction

The hallmark symptom of tear duct obstruction is persistent or intermittent tearing (epiphora). Symptoms may affect one or both eyes. Common complaints include:

Constant watering: Tears spilling onto the cheek without any external trigger such as wind or emotion
Periocular wetness: Chronic moisture around the eye causing skin irritation and redness
Sticky discharge: Mucopurulent material when infection develops at the site of blockage
Lacrimal sac swelling: A lump or fullness between the eye and the nose
Recurrent eye infections: Stagnant tears predisposing to bacterial overgrowth

Why Does the Duct Become Blocked?

In adults, the most common cause is age-related narrowing and eventual closure of the nasolacrimal duct due to chronic low-grade inflammation and fibrosis. Other causes include nasal trauma, post-sinus-surgery scarring, nasal polyps, and rarely tumours. In newborns, the most frequent cause is a membranous obstruction at the lower end of the nasolacrimal duct that failed to open at birth.

How Is It Diagnosed?

Diagnosis begins with a clinical examination. Pressing on the lacrimal sac area and observing whether mucus or purulent material refluxes from the punctum confirms the obstruction. Syringing the tear duct with saline and checking whether the fluid reaches the nose is a definitive test. When needed, imaging studies such as dacryocystography or dacryoscintigraphy can localise the site and degree of blockage.

Treatment in Infants

In newborns, the majority of congenital nasolacrimal duct obstructions resolve spontaneously within the first year with conservative measures. Parents are taught to perform lacrimal sac massage (Crigler massage) several times daily to help open the membrane. If the obstruction persists beyond 12 months, probing under brief general anaesthesia is typically performed.

Treatment in Adults

In adults, the definitive treatment is surgical. Dacryocystorhinostomy (DCR) creates a new drainage pathway from the lacrimal sac directly into the nasal cavity, bypassing the blocked duct. The procedure can be performed externally (through a small skin incision) or endoscopically (through the nose). High success rates are reported in the literature, though individual outcomes depend on the specific clinical situation. Early treatment prevents complications such as chronic dacryocystitis and, in rare cases, orbital cellulitis.

Tear Duct Obstruction: Symptoms and Treatment Options