Blocked Tear Ducts: Causes, Symptoms & Relief

Blocked tear ducts (epiphora) occur when tears cannot drain normally through the nasolacrimal system, causing overflow onto the cheek. Common in newborns and older adults.

Causes

Newborns (Congenital Nasolacrimal Duct Obstruction - CNLDO)

• Membrane at valve of Hasner (distal duct) fails to open—most common (90% resolve by 12 months).
• Duct narrowing, kinking, or absence.

Adults (Acquired)

• Age-related duct narrowing (involutional).
• Chronic conjunctivitis, blepharitis.
• Sinusitis, nasal polyps, deviated septum.
• Trauma (nasal/facial fractures).
• Medications (e.g., glaucoma drops, chemotherapy—docetaxel, 5-FU).
• Radiation therapy.
• Tumors (lacrimal sac, nasal, sinus).
• Autoimmune (Sjögren's, sarcoidosis, granulomatosis with polyangiitis).

Symptoms

• Persistent tearing (epiphora).
• Mucus or purulent discharge.
• Recurrent conjunctivitis or dacryocystitis (lacrimal sac infection: pain, swelling, redness at medial canthus).
• Blurred vision from tear film overflow.

Diagnosis

• History and slit-lamp exam.
• Dye disappearance test (fluorescein).
• Irrigation/probing (office procedure).
• Dacryocystography (DCG) or CT dacryocystography for complex cases.

Treatment

Infants

• Observation + lacrimal sac massage (Crigler massage) 4–6x/day.
• Topical antibiotics if discharge/infection.
• Probing at 9–12 months if persistent (90% success).
• Balloon dacryoplasty or intubation for failed probing.

Adults

• Treat underlying cause (sinusitis, medication review).
• Dilation and irrigation (temporary relief).
• Dacryocystorhinostomy (DCR): Surgical creation of new drainage pathway from lacrimal sac to nasal cavity. Gold standard (90–95% success). External or endoscopic approach.
• Jones tube (conjunctivodacryocystorhinostomy) for canalicular obstruction.

Prompt evaluation prevents chronic infection and quality-of-life impairment.