A clogged tear duct is a partial or complete blockage in the drainage system that normally carries tears from the surface of your eye into your nasal cavity. When this pathway is blocked, tears back up and pool on the eye’s surface, causing persistent watering, crustiness, and sometimes infection. It’s one of the most common eye conditions in newborns, affecting roughly 1 in 5 infants, but it can also develop in adults due to aging, injury, or chronic inflammation.
How Tear Drainage Works
Your eyes constantly produce tears to keep the surface moist and protected. After washing across the eye, tears drain through two tiny openings called puncta, located at the inner corners of your upper and lower eyelids. From there, they flow through small channels within the eyelids into the lacrimal sac, a small pouch that sits between your eye and the bridge of your nose. Tears then travel down a bony canal and exit into the nasal cavity, which is why your nose runs when you cry.
A blockage can happen at any point along this route, but the most common site is at the very bottom, where the duct opens into the nose. In newborns, this opening is the last part of the drainage system to fully develop, making it especially prone to obstruction.
Clogged Tear Ducts in Babies
Most infant tear duct blockages happen because a thin membrane at the bottom of the duct hasn’t opened by the time the baby is born. The good news: about 80% of these blockages resolve on their own within the first year of life. Parents typically notice symptoms within the first few weeks, including a watery eye, yellowish crusting on the lashes (especially after sleep), and mild discharge that can look like pink eye but keeps coming back.
In most cases, the infection that develops is low-grade and caused by normal bacteria that simply get trapped in the stagnant fluid. Babies with more severe blockages can develop redness and skin irritation around the eye from the near-constant moisture.
Lacrimal Sac Massage
The standard first-line treatment for infants is a specific massage technique applied to the tear sac. The goal is to build up enough pressure inside the sac to push through the membrane blocking the duct’s opening. To do it correctly, you place your index finger just inside the bony ridge next to the bridge of your baby’s nose and press firmly downward in short strokes. The recommended routine is 10 strokes, four times per day.
Technique matters here. Circular motions or sweeping down the side of the nose won’t generate enough pressure inside the sac to be effective. The finger needs to compress the sac directly. When done correctly, this massage resolves about 90% of blockages when started before 3 months of age, dropping to around 75% when started after 9 months.
Probing for Persistent Blockages
If the blockage hasn’t cleared by around 12 months, a doctor can perform a probing procedure. A thin, blunt instrument is gently passed through the drainage system to physically open the obstruction. Success rates are highest in younger infants, around 91% for babies under 6 months, and remain strong at about 85% between 6 and 12 months. After age 4, success rates drop to roughly 63%, which is why most ophthalmologists prefer not to wait too long before intervening.
Causes in Adults
In adults, tear duct blockages develop more gradually and for different reasons. Age-related narrowing is the most common cause. As you get older, the puncta and the duct itself can slowly narrow, eventually restricting flow enough to cause symptoms. This is more common in women than men, particularly after middle age.
Other causes include chronic sinus inflammation or nasal polyps that press on the duct from the outside, prior facial injuries or nose fractures that damage the bony canal, and repeated eye infections that scar the drainage channels. Rarely, a tumor near the duct can cause obstruction.
Symptoms to Recognize
The hallmark symptom is a persistently watery eye, often just on one side. Tears may spill over onto your cheek even when you’re not crying or exposed to wind. Other signs include:
- Crusting on the eyelids and lashes, especially noticeable in the morning
- Mucus or pus discharge from the inner corner of the eye
- Redness of the white of the eye
- Recurring pink eye infections that clear with antibiotics but keep coming back
When bacteria multiply in the stagnant fluid trapped behind the blockage, the tear sac itself can become infected, a condition called dacryocystitis. This causes painful swelling, redness, and tenderness at the inner corner of the eye near the nose. Dacryocystitis can come on suddenly and sometimes requires prompt treatment to prevent the infection from spreading.
How It’s Diagnosed
Doctors can often suspect a blocked tear duct from symptoms alone, but a few simple tests confirm the diagnosis and pinpoint where the blockage is. In the dye disappearance test, a drop of fluorescent dye is placed on the surface of each eye. If most of the dye is still sitting on the eye after five minutes instead of draining away, that confirms poor drainage on that side.
For a more direct assessment, a doctor may flush saline through the drainage system using a small syringe attached to the puncta. If the fluid doesn’t flow through to the nose, or if it backs up out of the other punctum, that tells the doctor exactly where the obstruction sits. A thin probe can also be inserted through the puncta to feel for the location of the blockage.
Surgery for Adults
When an adult tear duct blockage doesn’t respond to less invasive measures like flushing or widening the puncta, the most common surgical option is a procedure called dacryocystorhinostomy, or DCR. Rather than trying to reopen the original blocked duct, the surgeon creates a new drainage pathway that connects the tear sac directly to the nasal cavity, bypassing the obstruction entirely.
The surgery can be done from the outside through a small incision on the side of the nose, or entirely through the inside of the nose using an endoscopic approach. Both are performed under general anesthesia and are typically outpatient, meaning you go home the same day. A small silicone tube is often placed through the new opening to keep it from scarring shut during healing and is removed after several weeks or months.
Recovery is relatively quick. You’ll have a follow-up visit within a week to remove any packing placed during surgery, and stitches come out around the same time. Your doctor will typically prescribe a short course of antibiotics, anti-inflammatory drops, and a decongestant to reduce nasal swelling. Most people notice their tearing improves within the first few weeks, though full healing of the new drainage channel takes longer. The success rate for DCR surgery is high, generally above 90% for both the external and endoscopic approaches.