The lacrimal system is responsible for tear production and drainage. Tears, produced by the lacrimal glands, continuously wash across the eye’s surface to provide lubrication and protection. After serving their purpose, tears flow through tiny openings called puncta, into the lacrimal sac, and finally down the nasolacrimal duct into the nose. A blocked tear duct, medically termed dacryostenosis, occurs when this drainage pathway is partially or completely obstructed. This blockage causes the tear fluid to back up, leading to a variety of noticeable symptoms.
Answering the Pain Question
A simple blockage of the tear duct typically causes irritation and discomfort rather than sharp, acute pain. The obstruction leads to excessive tearing (epiphora), and the stagnant fluid can cause a sticky sensation and mild redness of the skin around the eye due to constant pooling and rubbing. True pain signals a more serious complication: dacryocystitis, an infection of the lacrimal sac. This infection causes the area at the inner corner of the eye, next to the nose, to become noticeably painful, red, and swollen. Acute dacryocystitis presents with tenderness and often a firm, inflamed lump, which may be accompanied by systemic symptoms like a fever, requiring immediate medical attention.
Recognizing the Common Signs
The most frequently observed sign of a blocked tear duct is epiphora, characterized by tears constantly spilling over the eyelid onto the cheek, even when the individual is not crying. This excessive watering occurs because the drainage system cannot keep pace with the eye’s normal tear production. Symptoms often become more pronounced when a person is exposed to cold or windy weather. Another common manifestation is a sticky or crusty buildup along the eyelashes and eyelids, particularly noticeable upon waking. Gentle pressure applied to the inner corner of the eye may release a clear, milky, or yellowish discharge from the puncta.
Understanding the Underlying Causes
Tear duct blockages can be separated into two main categories: congenital (present at birth) or acquired (developing later in life). Congenital nasolacrimal duct obstruction is the most common cause in infants, affecting approximately 6% of newborns. This occurs because a thin, membranous tissue, the Membrane of Hasner, fails to open completely at the bottom of the duct. In adults, blockages are typically acquired and arise from various sources that narrow or compress the drainage system. These sources include age-related changes that narrow the puncta, trauma to the face or nose causing scarring, chronic inflammation, recurrent eye infections, or nasal issues like polyps.
Treatment Options and Medical Intervention
For infants, initial management involves watchful waiting, as nearly 90% of congenital blockages resolve spontaneously by the child’s first birthday. During this time, parents may be instructed to perform the Crigler massage, applying firm, downward pressure to the lacrimal sac area to create hydrostatic pressure. If the blockage persists past 12 months or if recurrent infections develop, medical intervention becomes necessary. The first procedure often performed is nasolacrimal duct probing, where a thin instrument is gently passed through the duct to open the obstruction. For chronic adult blockages, a surgical procedure called dacryocystorhinostomy (DCR) is often required to create a new drainage pathway between the lacrimal sac and the nasal cavity, bypassing the obstruction entirely.