Eyes Blocked Tear Duct

Overview

A blocked tear duct means the tiny channel that drains tears from your eye down into your nose is partly or fully blocked. Tears normally wash across the eye and drain away through a small opening in the inner corner of the eyelid, then down a narrow tube into the nose. When that tube is blocked, tears have nowhere to go, so they spill over your cheek. The eye may also look sticky or gunky because tears and normal eye germs collect there. It is sometimes called a blocked nasolacrimal duct or, in babies, a blocked tear duct of infancy.

Yes. It is one of the most common eye complaints in babies, affecting roughly 1 in 5 newborns to some degree. In adults it is less common but still seen regularly, especially after middle age.

It affects newborns most often, because the drainage channel is still opening up in the first months of life. In older children and adults it can happen at any age, but it becomes more common as people get older, and it affects women a little more often than men.

Symptoms

Common symptoms

• Constant watering of one eye, sometimes both, even when you are not crying or in the wind
• Tears running down the cheek
• A sticky or crusty eyelid, especially after sleep
• Mild redness or soreness of the skin around the eye from constant wiping
• Blurred vision that clears when you blink or wipe the tears away
• Sometimes a small, soft swelling near the inner corner of the eye

Symptoms in children

• A watery eye in a baby, often noticed in the first few weeks of life
• Crusting or matting of the eyelashes, especially on waking
• Tears that well up when the baby is feeding or lying down
• Mild redness of the eye without much pain
• Usually only one eye is affected, though both can be
• Most babies are otherwise well and happy, with normal vision

Symptoms in older adults

• Watery, irritated eye that keeps coming back over months
• Frequent need to dab the eye, which can make the skin sore
• Recurrent mild eye infections or conjunctivitis
• A tender, red swelling at the inner corner of the eye, which may mean an infection of the tear sac
• Occasional discharge that smells or tastes unpleasant, because tears are not draining away
• Symptoms often worse in cold, windy weather

Causes

Main causes

• In babies: a thin membrane at the end of the tear duct that has not yet opened, or a duct that is simply narrow
• In adults: gradual narrowing of the drainage tube with age
• Infection or inflammation of the tear sac or nearby sinuses
• Injury or surgery around the eye, nose or cheek
• A blocked or damaged duct after an eye or nose operation
• Rarely, a growth or polyp pressing on the drainage channel
• Sometimes no clear cause is found

Risk factors

• Being a newborn, especially if born early
• Getting older, as ducts narrow over time
• Long-standing inflammation of the eyelids or eye surface
• Long-term use of some eye drops, including glaucoma drops
• Previous surgery or injury to the eye, nose or face
• Sinus problems or repeated sinus infections
• Having a close family member with the same problem
• Certain rare conditions that affect how the face and nose develop

When to see a doctor

See a doctor urgently if:

• A painful, red, swollen area at the inner corner of the eye, or a swelling that is getting bigger
• Fever with a swollen or very sticky eye
• Eye pain that is getting worse, or any change in vision
• A baby under 3 months with a red, swollen eye or discharge, as this needs same-day review

Book a routine appointment if:

• A watery, sticky eye that has lasted more than a few weeks
• Repeated eye infections in the same eye
• Constant watering that is bothering you or affecting daily life
• Your baby's watery eye has not cleared by about 12 months of age
• You are unsure what is causing the watering

Diagnosis

Most of the time a doctor can tell what is going on by listening to your story and looking closely at your eyes. They will check your vision, look at the eyelid and inner corner, and gently press near the tear sac to see if anything comes out. In babies, the pattern of a watery eye from early life with a normal-looking eye is usually enough to make the diagnosis.

Tests that may be done

• Vision check and a careful eye examination with a light
• A dye test, where a harmless coloured drop is placed in the eye and the doctor watches how quickly it drains away
• Gently flushing the tear duct with salt water to see whether it is open (done by an eye specialist)
• A small probe passed down the duct, usually under local or general anaesthetic, to locate the blockage
• A scan such as a CT or a special X-ray of the tear duct if the cause is unclear or before surgery

What to expect at your appointment

The first appointment is usually quick and painless, and nothing is put near your eye without explaining first. Some tests, such as flushing or probing, are done by an eye specialist and may be a little uncomfortable, so numbing drops are used. Children often need a short general anaesthetic for probing so they stay still and comfortable. You should get a clear explanation of the findings the same day.

Treatment

Treatment depends on your age and how much the blocked duct is bothering you. In babies, most cases need nothing more than time and gentle daily care, as the duct often opens by itself. In adults, treatment aims to clear any infection and then reopen or bypass the blocked channel if the watering keeps causing problems.

Self-care at home

• Keep the eye clean: wipe gently from the inner corner outwards with a clean, damp cloth, using a fresh cloth each time
• Wash your hands before and after touching the eye area
• For babies, ask your health visitor or doctor to show you how to gently massage the tear sac, as this can help open the duct
• Use cool or lukewarm compresses if the eyelid feels sore or crusty
• Avoid rubbing the eye, which irritates the skin and can spread germs
• Use sunglasses in windy or bright weather if watering bothers you
• Follow the instructions that come with any treatment your doctor recommends, and finish it as advised

Medical treatments

If there are signs of infection, your doctor may prescribe a course of antibiotic medicine or antibiotic eye drops, and these are chosen for you by a healthcare professional. Warm compresses and gentle cleaning often help alongside this. In babies, the first step is usually a period of watchful waiting with gentle massage, as most ducts open by themselves. If watering continues, an eye specialist may recommend a small procedure to open the duct, such as passing a fine probe, inflating a tiny balloon, or leaving a soft tube in place for a few months to keep the channel open. These are usually done as a day case.

When is surgery considered?

Surgery may be suggested if the watering keeps coming back, if there are repeated infections, or if the duct has not opened after a reasonable period of simpler treatment. In babies this is often around 12 months of age. In adults, a procedure called dacryocystorhinostomy (DCR) creates a new drainage opening from the tear sac straight into the nose, and it can be done from outside the face or from inside the nose. Your specialist will explain the options, the risks and what recovery involves for you.

Living with this condition

A watery eye is annoying more than harmful. Many people manage well by keeping tissues handy, wiping gently rather than rubbing, and using a clean cloth each time to reduce the chance of infection. It can help to keep a small mirror nearby so you can check the inner corner of the eye for redness or swelling. If you wear glasses or contact lenses, tell your optician if watering keeps affecting them.

Lifestyle tips

• Keep your hands clean and avoid touching your eyes with unwashed hands
• Blink regularly when using screens, as this helps spread tears evenly
• Wear glasses or sunglasses outdoors to shield the eyes from wind and glare
• Avoid smoke and very dry, dusty rooms where possible
• Use a clean towel and flannel, and do not share eye makeup or towels
• Replace eye makeup regularly and stop using any product that irritates the eye

Diet and exercise

There is no special diet that unblocks a tear duct. Eating a normal, balanced diet and drinking enough water supports general eye health. Exercise is safe and encouraged, and there is no need to avoid activity, though swimming goggles may help if you swim in chlorinated pools and your eye is irritated.

Mental health and emotional wellbeing

A constantly watery or sticky eye can be tiring and can affect confidence in social situations, and parents of babies with a watery eye often feel anxious about it. These feelings are normal. It can help to talk to your doctor, health visitor or pharmacist about what to expect and how long it may take, because clear information often reduces worry. If you or your child feel very distressed or low, tell a healthcare professional, and if you ever feel you cannot cope, contact your local crisis support service or emergency services.

Prevention

Most blocked tear ducts cannot be prevented, especially in newborns, because they are part of how the eye develops. You can reduce the chance of infection by keeping the eye area clean, washing your hands before touching your eyes, and not sharing eye makeup or towels.

Vaccines

There is no vaccine for a blocked tear duct.

Screening programmes

There is no specific screening programme for blocked tear ducts. Watery eyes are often noticed during routine newborn and child health checks, and at routine eye tests with an optometrist.

Complications

If left untreated

• Long-standing watering and skin irritation around the eye
• Repeated eye infections or conjunctivitis
• Infection of the tear sac, which causes a painful red swelling at the inner corner of the eye
• In rare cases, infection can spread to the tissue around the eye, which is serious and needs urgent treatment
• Blurred vision caused by tears in front of the eye, which clears when you wipe them away
• Rarely, a long-standing blockage can cause a collection of fluid that needs a procedure to drain

Long-term outlook

The outlook is good. Most babies with a blocked tear duct are completely better within the first year, often without any treatment. For the smaller number who need a small procedure, success rates are high, and many people need nothing more than one treatment. Adults with a blocked duct usually do well after treatment too. If watering comes back, it can be treated again, and your eye specialist will keep an eye on things.

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