Mayo Clinic Health Manager
Get free personalized health guidance for you and your family.
Get Started
About our e-newsletters
- Free e-newsletters
- Mayo Clinic expertise
- We do not share your e-mail address
Housecall, our weekly general-interest e-newsletter, keeps you up to date on a wide variety of health topics with timely, reliable, practical information, recipes, blogs, questions and answers with Mayo Clinic experts and more. Our biweekly topic-specific e-newsletters also include blogs, questions and answers with Mayo Clinic experts, and other useful information that will help you manage your health.
Housecall Archives
Mayo Clinic Housecall
Stay up to date on the latest health information.
What you get
- Free weekly e-newsletter
- Mayo Clinic expertise
- Recipes, tools and other helpful information
- We do not share your e-mail address
Treatments and drugs
By Mayo Clinic staffThe cause of your blocked tear duct will determine which treatment is right for you. Sometimes, more than one treatment or procedure is needed before a blocked tear duct is completely corrected.
If a tumor is causing your blocked tear duct, treatment will focus on the cause of the tumor. Surgery may be performed to remove the tumor, or your doctor may recommend using other treatments to shrink it.
Treatment options for non-tumor-blocked tear ducts vary from simple observation to surgery.
Conservative treatment
A high percentage of infants with congenital blocked tear duct improve on their own in the first several months of life, after the drainage system matures or the extra membrane involving the nasolacrimal duct opens up.
If the blocked tear duct isn't opening on its own, your doctor may recommend that you use a special massage technique to help open up the membrane covering the lower opening into your baby's nose. While pressing on the puncta on the inside of your baby's eye to prevent tears from coming back into the eye, stroke downward firmly on the inside of your baby's nose. This forces tears down the tear duct system, and could be enough pressure to break through the leftover membrane. Some parents report hearing a popping noise as the membrane breaks. The massage can be used two to four times a day, along with antibiotic drops to prevent infection.
Conservative treatment may be recommended if the tear ducts become blocked from tissue swelling after facial injury. In most cases of blocked tear ducts after such facial trauma, the drainage system starts functioning again on its own a few months after the injury, and no further treatment is needed. Your doctor may recommend waiting three to six months after your injury before considering the need for surgical intervention to open a blocked tear duct.
Minimally invasive treatment
Minimally invasive treatment options are used for infants and toddlers whose blocked tear ducts aren't opening on their own, or for adults who have a partially blocked duct or a partial narrowing (stenosis) of the puncta.
-
Dilation, probing and irrigation. This technique works to open congenital blocked tear ducts in most infants. The procedure can be done using general anesthesia, or using a restraint in very young babies. First, the doctor enlarges the puncta openings with a special dilation instrument, and then a thin probe is inserted through the puncta and into the tear duct system. The doctor threads the probe all the way out through the nasal opening, sometimes causing a popping noise as the probe pierces through the extra membrane. The probe is removed, and the tear duct system is flushed with a saline solution to clear out any remaining blockage. This treatment successfully clears blocked tear ducts in many infants less than 1 year of age.
For adults with partially narrowed puncta, a similar procedure is done in your doctor's office. The tear ducts are flushed and irrigated while the puncta are dilated. Antibiotics may be prescribed for any infections. If irrigation and dilation doesn't work, surgery may be necessary to open narrowed puncta. Sometimes, a small incision at the punctal opening may be all that's necessary.
- Balloon catheter dilation. This procedure opens tear drainage passages that are narrowed or blocked by scarring, inflammation and other acquired conditions. While you're under general anesthesia, a tube (catheter) with a deflated balloon on the tip is threaded through the lower nasolacrimal duct in your nose. The doctor then uses a pump to inflate and deflate the balloon a few times, sometimes moving it to different locations along the duct system. This procedure is more effective for infants and toddlers, but also is sometimes used in adults with partial blockage.
- Stenting or intubation. In this procedure, tiny silicone or polyurethane tubes are used to open up blockages and narrowing within the tear duct system. The procedure, which is done under general anesthesia, involves having a thin tube threaded through one or both puncta in the corner of your eye, all the way through the tear duct system and out through your nose. After the insertion, a small loop of tubing remains visible at the corner of your eye, but it's not usually bothersome. These tubes are generally left in for three to six months, then removed. Possible complications include inflammation from the presence of the tube.
Surgery
Surgery is still the most effective treatment for adults and older children with acquired blocked tear ducts. It's also highly successful in infants and toddlers with congenital blocked tear ducts, though it's typically used after other treatments have been tried.
The surgery used to treat most cases of blocked tear ducts (called dacryocystorhinostomy) reconstructs the passageway for tears to drain out through your nose normally again. First, you're given general anesthesia, or local anesthesia if it's performed as an outpatient procedure. The surgeon accesses your tear drainage system, then creates a new, direct connection between your lacrimal sac and your nose. This new route bypasses the duct that empties into your nose (nasolacrimal duct), which is the most common site of blockage. Stents or intubation typically are placed in the new route while it heals, and then removed three to six months after surgery.
The steps in this procedure vary, depending on the exact location and extent of your blockage, as well as your surgeon's expertise:
- External. An external dacryocystorhinostomy is still the most commonly used and highly successful surgical method of opening a blocked tear duct. Under general anesthesia, your surgeon makes an incision on the side of your nose, near where the lacrimal sac is located. After connecting the lacrimal sac to your nasal cavity and placing a stent in the new passageway, the surgeon closes up the incision with a few stitches.
- Endoscopic or endonasal. The same bypass procedure can be performed using endoscopic instruments. Instead of making an incision, the surgeon uses a microscopic camera and other tiny instruments inserted through the nasal opening to your duct system. Sometimes, a fiber-optic light is inserted into your puncta to illuminate the surgical area. The benefits of this method are that there's no incision and no scar, and the recovery typically is faster and easier. The drawbacks are that it requires a surgeon with special training, and the success rates aren't as high as with the external procedure.
- Bypassing the entire lacrimal duct system. Depending on the type of blockage, your surgeon may recommend a reconstruction of your entire tear drainage system (called conjunctivodacryocystorhinostomy). Instead of creating a new channel from the lacrimal sac to your nose, the surgeon will create a new route from the inside corner of your eyes (puncta) to your nose, bypassing the tear drainage system altogether.
Following surgery for a blocked tear duct, you'll use a nasal decongestant spray, as well as topical eyedrops to prevent infection and reduce postoperative inflammation. You'll continue these medications two to three times a day for two to three weeks following the procedure. After three to six months, you'll return for removal of any stents used to keep the new channel open while it healed.
- DelGaudio JM, et al. Nasolacrimal duct orifice cysts in adults: A previously unrecognized, easily treatable cause of epiphora. The Laryngoscope. 2007;117(10):1830-1833.
- Casady DR, et al. Stepwise treatment paradigm for congenital nasolacrimal duct obstruction. Ophthalmic Plastic and Reconstructive Surgery. 2006;22(4):243-247.
- Goldstein SM, et al. Comparison of monocanalicular stenting and balloon dacryoplasty in secondary treatment of congenital nasolacrimal duct obstruction after failed primary probing. Ophthalmic Plastic and Reconstructive Surgery. 2004;20(5):352-357.
- Becelli R et al. Posttraumatic obstruction of lacrimal pathways: A retrospective analysis of 58 consecutive naso-orbitoethmoid fractures. Journal of Craniofacial Surgery. 2004;15(1):29-33.
- Mandeville JT et al. Obstruction of the lacrimal drainage system. Current Opinion in Ophthalmology. 2002;13(5):303-309.
- Tan AD, et al. Congenital nasolacrimal duct obstruction. International Ophthalmology Clinics. 2001;41(4):57-69.
- Mills DM, et al. Acquired nasolacrimal duct obstruction. Otolaryngology Clinics of North America. 2006;39(5):979-999.
- Kapadia MK, et al. Evaluation and management of congenital nasolacrimal duct obstruction. Otolaryngology Clinics of North America. 2006;39(5):959-977.
- Woog JJ, et al. Endoscopic dacryocystorhinostomy and conjuctivodacryocystorhinostomy. Otolaryngology Clinics of North America. 2006;39(5):1001-1017.
- Hurwitz JJ. The Lacrimal drainage system. In: Yanoff. Ophthalmology. 2nd ed. Philadelphia, Pa.:Mosby Inc.; 2006. http://www.mdconsult.com/das/book/body/104049824-3/744373637/1197/56.html#4-u1.0-B0-323-01634-0..50102-4_2729. Accessed July 29, 2008.
