Topic Overview
What is a blocked tear duct?
Tears normally drain
from the eye through small tubes called tear ducts that stretch from the eye
into the nose. A blocked tear duct occurs when the duct that
normally allows
tears to drain from the eyes is obstructed or fails to
open properly. If a tear duct remains blocked, the tear duct sac fills with
fluid and may become swollen and inflamed, and sometimes infected.
Blocked tear ducts occur in about 6 out of 100 newborns.1 A blocked tear duct that is present at birth is
called congenital nasolacrimal duct obstruction.
Blocked tear ducts are
less common in adults. An adult may get a blocked duct because of aging or an injury.
What causes a blocked tear duct?
In babies, the
most common cause of a blocked tear duct is the failure of the thin tissue at
the end of the tear duct to open normally.
Other less common
causes of blocked tear ducts in children include:
- Infections.
- Abnormal growth of
the nasal bone that puts pressure on a tear duct and closes it
off.
- Closed or undeveloped openings in the corners of the eyes
(puncta) where tears drain into the tear ducts.
In adults, tear ducts may become blocked as a result of a
thickening of the tear duct lining, nasal or sinus problems, injuries to the
bone and tissues around the eyes (such as the cheekbones), infections, or
abnormal growths such as tumors.
What are the symptoms?
Usually, the first symptom
of a blocked tear duct is excessive tearing, ranging from a wet appearance of
the eye to tears running down the cheek. Babies who have blocked tear ducts
usually have symptoms within the first few days to the first few weeks after
birth. If infection occurs in the
eye's drainage system, you may see redness and swelling (inflammation) around the eye or nose. Also, yellow
mucus can build up in the corner of the eye, and the
eyelids may stick together. In severe cases, infection can spread to the
eyelids and the area around the eye.
The symptoms of a blocked
tear duct may get worse after an
upper respiratory infection, such as a cold or sinus
infection. Also, symptoms may be more noticeable after exposure to wind, cold,
and sunlight.
How is a blocked tear duct diagnosed?
A blocked
tear duct is diagnosed based on a medical history and a physical exam. Also,
tests may be used to measure the amount of tears or to see whether tears are
draining normally from the eyes. Other tests can help your doctor find out
where the blockage is or how it was caused.
How is it treated?
Babies born with blocked tear
ducts usually do not need treatment. Most blocked ducts clear up on their own
by 1 year of age. But home treatment measures that keep the eye clean and help
drain the duct can help prevent infection.
Antibiotics usually are needed if signs of infection
appear, such as redness, swelling, or yellowish discharge.
If the
duct remains blocked after the baby is 6 months to about 1 year old, a probing
procedure may be done. Probing successfully opens the duct for about 90 out of
100 babies who have blocked ducts.1 Probing is not
usually done for adults, because it rarely helps.
Some people may need surgery for
structural problems or abnormal growths.
Frequently Asked Questions (FAQs)
Learning about blocked tear ducts: | |
Being diagnosed: | |
Getting treatment: | |
Living with a blocked tear duct: | |
Cause
The most common cause of a
blocked tear duct is the failure of the thin tissue,
or membrane, that covers the tear duct (lacrimal duct) to open normally into
the nasal passage shortly after birth. This disrupts the usual
drainage system for tears.
Symptoms
usually are not noticed if the blockage resolves on its own before a baby
starts producing
tears. Normally, tears start forming within the first
few days to weeks following birth.
Less common causes of blocked
tear ducts in babies can include:
- Infection in the tubes that drain tears from
the eyes to the nose (dacryocystitis).
- Blockage of the tear duct at
both ends (dacryocystocele).
- Abnormal growth of the
nasal bone that puts pressure on a tear duct, closing it off.
-
Closed or undeveloped holes in the corners of the eyes (puncta) where tears
normally flow into the tear ducts.
Blocked tear ducts in adults
The
cause of blocked tear ducts in adults is usually
related to another disorder or an injury. For example, a blocked tear duct may
result from a thickening of the tear duct lining, abnormal tissue or structures
in the nose, or complications of surgery on or around the nose.
Symptoms
Babies with
blocked tear ducts usually have symptoms after they
start producing
tears, which can be any time from the first few days
to the first few weeks after birth. Symptoms often affect only one eye and
usually include:
- Excessive tearing. The eye may appear moist or
wet with or without drops flowing down the face (epiphora). Very few babies
produce a heavy stream of tears.
- Buildup of a yellowish white
substance at the inner corner of the eye. It may also collect on the eyelashes
and the lining of the eyelids (conjunctiva). The eyelids may stick together,
especially after sleeping.
- Swelling and redness of the eyelids and
irritation of the surrounding skin. If a tear duct (lacrimal duct) remains
partially or completely blocked, the tear duct sac fills with fluid, and an
infection can develop in the drainage system. The infection may cause fever,
inflammation (redness and swelling) and tenderness alongside the nose, and
mucus or pus in the eye.
The symptoms of a blocked tear duct may get worse after an
upper respiratory infection, such as a cold or sinus infection. Also, symptoms
may be more noticeable after exposure to wind, cold, and sunlight.
What Happens
Tear ducts can be fully or
partially
blocked. The blockage causes tears to back up inside
the tear duct system and may cause the tears to overflow onto the face
(epiphora). The blockage may also allow infection to develop in the tear ducts
as bacteria and other substances collect in the eye.
Most blocked
tear ducts are present at birth (congenital) and resolve on their own before a
baby is 1 year old.1 A few babies may need
probing to open the ducts. Probing done around age 1
usually works well, and most babies don't need it done again.2
A blocked tear duct by itself usually does not
permanently affect a baby's vision or increase the likelihood of having other
eye problems.
Infections may develop many times in the affected
eye. In rare cases, infection may spread to the eyelids and skin around the eye
(periorbital cellulitis). Sometimes a pus-filled sac (dacryocystitis)
also forms.
In adults, blocked tear ducts may be caused by
infection, structural problems related to injury or surgery, or abnormal
growths within the drainage system. Treatment for a blocked tear duct depends
on the cause.
- Infections usually clear up with
antibiotics.
- If structural changes or abnormal growths are causing the tear
duct blockage, surgery may be needed to correct the problem.
What Increases Your Risk
Risk factors for a
blocked tear duct include:
- Being born early (premature).
- Problems with the structure or
functioning of the
drainage system for tears (caused by infection,
abnormal bone growth, or tumors).
- A family history of blocked tear
duct.
When To Call a Doctor
Call your doctor if you or your
baby has:
- Swelling and redness of the eyelid, the eyelid
lining, the white part of the eye (sclera), or the tissue around the eye
(usually just on one side).
- A fever and symptoms of an eye
infection, such as eye drainage and swelling, redness, and tenderness alongside
the nose. A baby may be fussy and may rub the affected eye
often.
- Difficulty seeing or difficulty moving one or both
eyes.
- Eye pain or discomfort.
- Excessive tearing in one
or both eyes for more than a week.
The following signs may point to other problems with the
tear duct. Call your doctor if you have or if your baby has:
- Thick, yellow drainage in the corner or on the
surface of the eye.
- Eyelids that are matted by mucus in the
morning.
- A bluish swelling inside and below the lower eyelid (dacryocystocele). In babies, this swelling may appear
several days after birth. In adults, this may appear during a period of
excessive tearing.
- A reddish swelling inside and below the lower
eyelid. The eye may have crusty mucus drainage. And the area below the eyelid
may be painful.
Call your doctor if you notice excessive tearing in one or
both eyes and have:
- Pain, tenderness, or a feeling of pressure in
your face and forehead over the area of your sinuses. For more information, see
the topic
Sinusitis.
- Bloody nasal drainage that
lasts for more than a day.
Watchful Waiting
Watchful waiting for 1 to 2 weeks is
appropriate in most cases of blocked tear ducts in babies. They usually clear
up on their own or with treatment before the baby's first birthday.
Watchful waiting for 1 to 2 weeks also is appropriate for adults with a
blocked tear duct without signs of infection. The condition may clear up on its
own.
Watchful waiting is not appropriate if you develop excessive
tearing in one or both eyes and you:
- Had a recent injury to your face or
nose.
- Have signs of infection (such as thick, yellow drainage or
crusted mucus in the eye).
- Had recent nasal or sinus
surgery.
Who To See
A child or an
adult with a blocked tear duct may see:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
A
blocked tear duct is diagnosed based on a
medical history, a
physical exam, and other testing as needed.
Tests for children and adults may include:
Additional tests are sometimes used, although usually only
with adults. These tests may include:
- A Schirmer test, used to find out whether the
tear glands are producing the normal amount of tears. Special small, soft paper
strips are placed in the corner of the person's eyes for about 5 minutes to see
how many tears are produced.
- Probing to find out if the duct is blocked. The area
is numbed with a local anesthetic before the probe is
inserted
- Imaging tests, such as
computed tomography (CT scan) or
magnetic resonance imaging (MRI) of the head. Imaging
tests may be done to locate the site and structural cause of the tear duct
blockage.
Treatment Overview
Most of the time, a
blocked tear duct clears up on its own by the time a
baby is 1 year old. To help prevent infection, keep the eye clean. And if your doctor suggests it, gently massage the area of the blockage so fluid does not build up in the duct.
If signs of infection develop, your baby may need an
antibiotic.
If the duct remains
blocked after your baby is 6 months to 1 year old,
probing may be done to open the duct. In rare cases,
babies with blocked tear ducts have a more severe problem that requires more
complicated surgery.
Blocked Tear Ducts: Should My Baby Have a Probing Procedure?
In adults, treatment depends on the cause of the blockage.
If the duct is blocked due to a long-term (chronic) infection, antibiotic
medicines are used. Surgery for blocked tear ducts may be needed for structural
problems of the drainage system (such as from injury or age-related changes) or
abnormal growths.
Prevention
Most
blocked tear ducts cannot be prevented. The majority
of blocked tear ducts are present at birth (congenital) when the thin tissue
covering the tear duct does not open normally.
But you can help
prevent some conditions that can cause blocked tear ducts, such as:
- Sinus or eye infections. If you have symptoms
of these types of infections, see your doctor right away for treatment. For
more information, see the topic
Sinusitis or
Pinkeye.
- Facial injuries. Wear a helmet
when you play contact sports such as football.
Home Treatment
Blocked tear ducts most often occur in babies. If your baby is born with a blocked
tear duct, it will usually clear up on its own by 1 year of age.
You can help prevent infection in your or your baby's blocked tear duct
by keeping the eye clean and using gentle massage techniques. Wash your hands
before and after touching the eye area.
To keep the eye
clean:
- Wipe away the drainage from around the eye. Moisten
a clean cotton ball or washcloth with warm (not hot) water, and gently wipe
from the inner (near the nose) to the outer part of the eye. With each wipe,
use a new or clean part of the cotton ball or washcloth. Keep a supply of clean
cotton balls moistened with water in a sealed plastic bag for use when you are
away from home.
- If eyelashes become crusted with drainage, clean
them with a moist cotton ball using a gentle, downward motion. If the eyelids
become stuck together, place a clean, warm, wet cotton ball over that eye for a
few minutes to help loosen the crust.
Massage should only be used under the advice and direction
of a doctor. Usually, it is done 2 or 3 times a day for several months.
If your baby has blocked ducts, limit his or her time in
the wind, cold, and sunlight. This can help prevent symptoms from getting
worse.
Medications
Blocked tear ducts prevent the eye's drainage system from working properly and make
it prone to infection.
Antibiotics are needed if signs of infection develop,
such as redness, tenderness, swelling in or around the eye, and
mucus that looks like it contains pus.
Some antibiotic solutions and ointments are applied directly to the eye
(ophthalmic antibiotics), while some are taken by mouth (systemic antibiotics).
They may also be used to try to prevent infection, although they have not been
proved effective for this purpose. Antibiotics for more serious or long-term
(chronic) infections can help reduce scarring of the
drainage system for tears.
To learn the
best way to use medicines that you put in your eye, see:
Eye Problems: Using Eyedrops and Eye Ointment.
Surgery
Most babies born with a
blocked tear duct will not need surgery. But when
surgery is needed, probing is usually done. During probing, the doctor passes a probe through the blocked tear duct to open it.
Probing may be
done with
local anesthesia (numbing eyedrops) in the doctor's office. Or in an
outpatient setting, general anesthesia may be used. The type of anesthesia depends on your child's age and the eye doctor's preference.
For adults, treatment for a blocked tear duct depends on
its cause. Probing is typically not effective with adults, and other surgical
procedures are usually used.
Other types of surgery for a blocked
tear duct in babies or adults may include breaking a nasal bone, placing a tube
in the tear duct, or surgically creating a new tear duct.
Surgery Choices
Surgical options for a blocked tear duct include:
- Probing, which involves passing a probe through the blocked tear duct to open it. Probing successfully opens the
duct in about 90 out of 100 babies who have blocked ducts.1
- Blocked Tear Ducts: Should My Baby Have a Probing Procedure?
- Intubation, which involves placing a
silicone tube through the tear duct to create a passageway for tears to drain
into the nostril. This may be done if the duct has excessive scarring or if it
is hard to pass the probe through the duct. Intubation may also be needed
if probing is being repeated because a previous probing failed to open the tear
duct.
- Infracturing, in which a nasal bone deep within the
nose is broken to create an open duct and improve a passageway into the
nostril. Infracturing will not permanently affect the size or shape of a baby's
nose.
- Balloon dacryocystoplasty, in which a tiny balloon at
the end of a probe is used to open the tear duct.
Surgical options that are rarely used for children—and
only after the above procedures have failed—include:
When you talk about surgery options with your child's
doctor, use this
surgery information form(What is a PDF document?).
In adults, treatment for a blocked
tear duct depends on the cause of the blockage and can include any of the above
choices.
What To Think About
About 6 weeks after a surgical
treatment, you or your child will most likely visit the doctor for an eye exam
and may be tested again with the
fluorescein dye disappearance test.
Other Places To Get Help
Organizations
| American Association for Pediatric Ophthalmology and
Strabismus |
| P.O. Box 193832 |
| San Francisco, CA 94119-3832 |
| Phone: | (415) 561-8505 |
| Fax: | (415) 561-8531 |
| Email: | aapos@aao.org |
| Web Address: | www.aapos.org |
| |
The American Association for Pediatric Ophthalmology and Strabismus
(AAPOS) provides information and encourages research on medical and surgical
eye care for children and adults with strabismus. |
|
| EyeCare America |
| P.O. Box 429098 |
| San Francisco, CA 94142-9098 |
| USA |
| Phone: | 1-877-887-6327 toll-free |
| Fax: | (415) 561-8567 |
| Email: | pubserv@aao.org |
| Web Address: | www.eyecareamerica.org |
| |
EyeCare America is a public service program of the
Foundation of the American Academy of Ophthalmology that raises awareness about
eye diseases and eye care. This site provides educational materials and
information about how to get medical eye care. |
|
| KidsHealth for Parents, Children, and
Teens |
| 10140 Centurion Parkway North |
| Jacksonville, FL 32256 |
| Phone: | (904) 697-4100 |
| Fax: | (904) 697-4125 |
| Web Address: | www.kidshealth.org |
| |
This Web site is sponsored by the Nemours Foundation. It
has a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This Web site
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly e-mails about your area of interest. |
|
References
Citations
- Olitsky SE, et al. (2007). Disorders of the lacrimal
system. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., chap. 624, p. 2587. Philadelphia: Saunders
Elsevier.
- Mills MD, Khazaeni LM (2006). Nasolacrimal duct
obstruction. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 1098–1099. Philadelphia: Saunders
Elsevier.
Other Works Consulted
- Braverman RS (2009). Nasolacrimal duct obstruction section of Eye. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 19th ed., p. 407. New York: McGraw-Hill.
- Soparkar CNS, Patrinely JR (2002). Orbit and lacrimal
system. In DH Gold, RA Lewis, eds., Clinical Eye Atlas,
chap. 14, pp. 1408–1418. Chicago: American Medical Association.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Susan C. Kim, MD - Pediatrics |
|---|
| Specialist Medical Reviewer | Christopher J. Rudnisky, MD, MPH, FRCSC - Ophthalmology |
|---|
| Last Revised | April 6, 2010 |
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