Blocked tear duct: treatment, symptoms and causes in adults and babies

Treatment depends on age, how severe the watering is and what is causing it. Moorfields Eye Hospital says treatment may not be necessary in mild cases. Hospital leaflets describe the usual steps in adults and in babies below.

In adults, Hull University Teaching Hospitals says warm compresses and massage may be tried first to unblock the area, and that sometimes it is possible to unblock the tear duct by syringing, which involves flushing salty water down the tear duct. If the tear duct is open, you will taste the salty water in your throat. If the blockage persists, the definitive treatment is surgery.

Cambridge University Hospitals describes dacryocystorhinostomy (DCR) as an operation that bypasses the blocked tear duct and provides an alternative route for tears to drain from the eye into the nose. A piece of bone is removed from the side wall of the nose and the tear sac is connected directly to the nasal cavity, either through a cut in the skin on the side of the nose (external DCR) or by looking up the nose with a small telescope (endoscopic DCR).

A temporary silicone tube (stent) is usually left in place to keep the new channel open while tissues heal. Cambridge says it is normally removed about six weeks after the operation in a simple outpatient procedure, and Hull says 6 to 8 weeks. Guy's and St Thomas' says DCR is usually done under general anaesthetic as a day case.

Guy's and St Thomas' says a DCR is generally safe but there are risks. Bruising and swelling are common and can last a few weeks. Infection in the wound is possible. Nosebleeds can happen up to 10 days after surgery, in 1 or 2 in every 100 people, and usually stop by themselves. Occasionally scarring can cause the tear duct to block again, and more surgery may be needed.

Cambridge says to avoid blowing your nose for the first ten days and vigorous physical activity or swimming for a fortnight, and to contact the emergency eye clinic or emergency department if a nosebleed does not stop after pinching the nose. Guy's and St Thomas' says around 8 in 10 people experience a significant improvement in watering of the eye, so the results vary between hospitals and people, and it is worth asking your own surgeon what to expect.

Moorfields Eye Hospital says if your tear ducts are blocked or narrowed, tears cannot drain away and remain in the tear sac. The tear sac may become infected and your eye will produce a sticky liquid. You may also have a swelling on the side of your nose, next to your eye.

• Watering, so that tears spill over onto the cheek.

• Sticky or crusty discharge, especially after sleep. Cambridge says stagnation of tears and mucus in the tear sac can spill back into the eye.

• In babies, tears pooling in the corners of the eye or spilling onto the cheeks, noticeable even when the child is not crying, and sticky or crusted eyes on waking (Hull).

• Symptoms that can get worse in colder weather or with a cold (Hull, babies).

• Repeated eye infections, in children (Hull).

• Swelling on the side of the nose next to the eye, if the tear sac is infected (Moorfields).

In babies, Hull says it is not entirely understood why the tear ducts do not fully open. Moorfields says babies are sometimes born with tear ducts that have not fully developed, and as they finish developing, usually within a few weeks of birth, the problem disappears.

In adults, Moorfields says a blocked or narrowed tear duct is the most common cause of a watering eye. Over time the ducts can narrow, often because of inflammation (swelling). Guy's and St Thomas' says the tear duct narrows with age so the system overflows and tears roll down the cheeks, which can be more noticeable in windy or cold conditions. Other causes of blockage include facial injuries and some conditions affecting the nose or sinuses. Moorfields adds that the narrow drainage channels on the inside of the eyes (canaliculi) may occasionally become blocked through inflammation or scarring.

Not every watering eye is a blocked duct. Moorfields lists other causes, which are treated differently.

• Irritants, such as fumes or grit in the eye.

• An eye infection such as infective conjunctivitis, or allergic conjunctivitis.

• An inward-growing eyelash, or an eyelid that turns outwards (ectropion), so that tears do not drain properly.

Moorfields Eye Hospital explains that the lacrimal gland constantly produces tears to keep the eyes moist. Excess tears drain away through tiny channels (canaliculi) on the inside of the eyes into a tear sac, then down the tear duct into the nose. If the tear ducts become blocked or narrowed, excess tears build up and overflow.

Moorfields says watering eye can happen at any age but is most common in young babies (0 to 12 months) and people over 60, and that it can affect one or both eyes.

In babies, Hull says in most cases the problem will have resolved by 1 year of age, in nine out of ten cases without intervention. If it persists after that age or the baby has repeated eye infections, an operation may be considered, although there is no necessity to have it as there is still a chance the problem may resolve on its own by the age of 5 years.

For adults, the hospital leaflets describe surgery as the definitive treatment when the blockage persists. After DCR, bruising and swelling of the eyelids usually settle in about a fortnight (Cambridge), and the stent is removed after about 6 to 8 weeks.

See a GP if watering or sticky eyes persist, if you have repeated infections or if there is swelling at the side of the nose. A GP can refer you to an eye specialist, who will assess the drainage system, for example by flushing salty water through the tear ducts and examining the inside of the nose (Guy's and St Thomas').

For eye symptoms in general, the NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have pain in your eyes, sensitivity to light, changes in your vision such as wavy lines or flashing, or very red eyes, as these can be signs of a more serious eye problem. It says to get an urgent GP appointment if a baby less than 30 days old has red, sticky eyes, and to see a GP if your baby has red, sticky eyes.

Hull notes that babies with blocked tear ducts may develop conjunctivitis (a red, inflamed eye), in which case antibiotic drops may be required.

On the NHS, a GP refers you to an ophthalmology (eye) department, where the drainage system is assessed and, if needed, you are placed on the waiting list for DCR. Babies are usually looked after with advice from a GP, health visitor or eye clinic, and referred if the problem persists.

Some adults choose to see a private ophthalmologist or oculoplastic surgeon, usually for quicker access. The operations are the same. Ask which type of DCR is recommended and why, what success rate the surgeon quotes, and how follow-up and stent removal will be arranged.