Nasolacrimal Duct Obstruction (Blocked Tear Duct)

What is Nasolacrimal Duct Obstruction (Blocked Tear Duct)?

The nasolacrimal duct drains tears from the inner corner of each eye down into the nose. When this channel becomes blocked, tears overflow down the cheek (epiphora) and the eye may become sticky with discharge due to secondary infection. In babies, congenital nasolacrimal duct obstruction is very common — affecting up to 20% of newborns — and most resolve spontaneously within the first year of life. In adults, obstruction is usually acquired and may require surgical treatment.

Symptoms

• Persistently watering eye (epiphora)
• Sticky or mucoid discharge, particularly on waking
• Repeated conjunctivitis-like episodes
• A visible swelling at the inner corner of the eye (dacryocele in infants)
• Skin irritation below the inner eye from constant wetness

Causes

• Congenital — failure of the lower end of the nasolacrimal duct to open at birth (most cases resolve by 12 months)
• Acquired in adults — chronic inflammation, infection (dacryocystitis), nasal polyps, facial trauma, previous nasal surgery, systemic conditions (sarcoidosis, lymphoma)
• Punctal stenosis — narrowing of the tear drainage opening on the eyelid margin

Diagnosis

Slit-lamp examination, syringing and probing of the lacrimal drainage system under topical anaesthetic. CT dacryocystography may be used in complex adult cases.

Treatment

In infants: lacrimal massage (Crigler massage) combined with topical antibiotics for secondary infection. Probing and syringing under general anaesthetic if not resolved by 12–15 months. In adults: balloon dacryoplasty or dacryocystorhinostomy (DCR) — a surgical procedure to create a new drainage channel directly into the nasal cavity.