Have you ever experienced persistent watery eyes and wondered what could be causing them? Blocked tear ducts could be the culprit, leading to discomfort and even infections if left untreated. In this blog post, we will dive deep into the world of blocked tear ducts, exploring the causes, symptoms, and the surgical treatment known as Dacryocystorhinostomy (DCR) or 1 tear duct surgery. By understanding this condition, we can make informed decisions and take appropriate steps to maintain optimal eye health.

Key Takeaways

  • Understanding and treating a blocked tear duct requires knowledge of its anatomy, causes, symptoms and diagnosis.
  • Dacryocystorhinostomy (DCR) is the main surgical procedure used to treat blocked tear ducts with external or endoscopic options available. Risks include infection & scarring.
  • Non-surgical alternatives may be effective depending on severity & cause. Consult an eye doctor for timely diagnosis & treatment.

Understanding Blocked Tear Ducts

Tear duct blockage, a condition where the tear ducts that typically facilitate the drainage of tears become obstructed, can lead to excessive tearing and eye discomfort. Blocked tear ducts are not uncommon, with an estimated 6 to 20 percent of newborns developing nasolacrimal duct obstruction. It can also affect adults, resulting from infections, inflammation, or mechanical obstructions.

The underlying cause of excessive tearing due to blocked tear ducts is the obstruction of the outflow of tears. Healthcare professionals need to grasp the anatomy and causes of blocked tear ducts accurately to diagnose and offer suitable treatment options for their patients.

Anatomy of the Tear Drainage System

The tear drainage system, also known as the lacrimal outflow system, is a complex structure designed to keep our eyes moist and healthy. It consists of minute openings in the eyelids, a narrow tube, the lacrimal sac, the tear duct, and the nasal cavity. The primary components of the adult lacrimal system include the orbital and palpebral lobe lacrimal glands, accessory lacrimal glands, and mucin secretors.

Dry eyes can result from various factors, such as medications, environmental irritants, diseases of the eye or skin around the eyes, systemic diseases, and extended use of digital devices. Decreasing screen time, identifying and avoiding triggers, sleeping with a humidifier, and using artificial tears or eye drops can help manage dry eyes.

Common Causes of Blocked Tear Ducts

Blocked tear ducts can be attributed to several factors, including infections, inflammation, and mechanical obstructions. Infectious diseases like conjunctivitis and blepharitis can lead to watery eyes. For instance, bacterial conjunctivitis can be treated with antibiotics, while viral conjunctivitis can be managed with artificial tears and cool compresses.

The most common cause of lacrimal pathway obstructions is the blockage of the nasolacrimal duct, accounting for 67.6% of all cases. In adults, potential causes include:

  • Infections
  • Inflammation
  • Tumors
  • Traumatic injuries
  • Other forms of mechanical blockage
  • Lacrimal pump weakness

In infants, congenital nasolacrimal duct obstruction is the most frequent cause of epiphora, or excessive tearing.

Symptoms and Diagnosis of Blocked Tear Ducts

A person with watery eyes, indicating a blocked tear duct

It’s beneficial to seek timely medical attention upon recognizing the symptoms of a blocked tear duct. The primary indicators of a blocked tear duct include watery eyes, recurrent eye infections, and, of course, a blocked tear duct. To determine the cause of watery eyes, ophthalmologists will inspect the eyes and conduct tests on the quantity and quality of tears, as well as the rate at which tears are drained away.

Once the cause is identified, the eye doctor may recommend treatments such as artificial tears, anti-inflammatory medications, and allergy medications to address dry eyes or allergies. Proper diagnosis ensures that patients receive the appropriate treatment to resolve their symptoms and maintain optimal eye health.

Recognizing the Symptoms

Blocked tear ducts can present various symptoms that may indicate the need for further examination. Excessive eye watering or crusting around the eye may be observed, and in the event the duct is infected, additional symptoms may be present. Epiphora, characterized by excessive tearing, may also be an indication of a blocked tear duct.

Awareness of these symptoms and consultation with an eye doctor if they persist is pivotal. Prompt diagnosis and intervention can avert complications, ensuring the tear drainage system works effectively for comfortable and healthy eyes.

Diagnostic Procedures

Diagnosing a blocked tear duct involves several tests and imaging techniques. These may include:

  • Tear drainage test
  • Comprehensive medical eye exam
  • Special eye stain
  • X-ray studies
  • Use of dye to test tear drainage

These diagnostic procedures help eye doctors accurately assess the tear drainage system and identify obstructions, leading to appropriate treatment options for the patient.

Undergoing these diagnostic procedures is vital for identifying and addressing any underlying issues. Accurate diagnosis enables eye doctors to suggest appropriate treatment options, like ophthalmic plastic surgery procedures such as Dacryocystorhinostomy (DCR), to resolve the blocked tear duct and restore normal tear drainage.

One Tear Duct Surgery: Dacryocystorhinostomy (DCR)

A diagram of the external DCR procedure, showing the skin incision, lacrimal fossa, and medial canthal tendon

Dacryocystorhinostomy (DCR) is a surgical procedure that creates a new drainage pathway for tears in order to treat blocked tear ducts. The surgery involves:

  1. Removing nearby bone close to the nasolacrimal sac.
  2. Fusing the lacrimal sac with the lateral nasal mucosa to overcome the philtrum of the nasolacrimal duct.
  3. Creating a low-resistance pathway for tear fluid by draining the canaliculi directly into the nasal cavity.

This procedure facilitates the more efficient travel of tear fluid, providing relief to the tear-producing lacrimal glands and ensuring proper functioning of the lacrimal fossa.

There are two main options for DCR surgery: external DCR and endoscopic DCR. Both procedures aim to create a new drainage pathway for tears, but the techniques used and their advantages differ.

External DCR

An image showing the process of 1 tear duct surgery for External DCR.

External DCR involves the following steps:

  1. Making a small incision near the tear duct
  2. Inserting a tube to keep the new pathway open
  3. Making a curvilinear skin incision at the level of the medial canthal tendon
  4. Extending the incision into the lower lid for about 10-12 mm.

Although effective, external DCR carries potential risks, including infection, scarring, and recurrence of the blockage. Post-operative care and recovery involve ensuring the eye remains clean and free of debris, abstaining from strenuous activities, and adhering to any prescribed medications.

Endoscopic DCR

Endoscopic DCR is a minimally invasive procedure that creates a new opening from the lacrimal sac to the nasal cavity using a small tube. This procedure is conducted by both sinus surgeons and eye surgeons and involves using an endoscope to form a new opening directly from the lacrimal sac to facilitate tear drainage.

Endoscopic DCR carries the risks of infection, bleeding, scarring, and damage to the surrounding structures. However, it is generally less invasive than external DCR. Post-operative care and recovery for endoscopic DCR involve taking antibiotics, using eye drops, and avoiding strenuous activities.

Risks and Complications

As with any surgical procedure, DCR carries potential risks and complications. These may include infection, scarring, and the failure to resolve symptoms. The risks of infection associated with DCR surgery include abnormal tissue fusion in the nose, displacement of the stent placed in the duct, excessive bleeding, infection, and a visible facial scar.

Awareness of these potential risks and complications allows patients to make informed decisions about DCR surgery and address their concerns with their eye doctor. The decision to undergo DCR surgery should take into account symptom severity, potential procedure benefits, and possible complications.

Preparing for DCR Surgery

A person preparing for DCR surgery, with a doctor and medical equipment

Prior to DCR surgery, patients should:

  • Make necessary adjustments to their medications as advised by their doctor
  • Fast before the procedure as required
  • Undergo pre-operative tests to evaluate their anatomy and ensure a successful surgery while minimizing potential complications.

Preparation for DCR surgery is a critical step in the process, contributing to the best possible patient outcome. Adhering to the doctor’s instructions can enhance the likelihood of a successful surgery and a smooth recovery.

Post-Operative Care and Recovery

A person recovering from DCR surgery, with a bandage over the eye

After DCR surgery, patients should follow specific post-operative care instructions to ensure proper healing and recovery. These may include:

  • Resting for one week
  • Abstaining from heavy lifting and strenuous activity
  • Refraining from consuming hot drinks and food for the first 12-24 hours
  • Applying ice/cold compresses for 48 hours
  • Maintaining their head elevated at a 45-degree angle
  • Avoiding nose blowing for one week

Post-DCR surgery care aims to monitor the patient’s progress and remove the stent if necessary. Patients should immediately contact their doctor if they experience excessive bleeding, fever, or escalating pain or swelling after the surgery.

Non-Surgical Alternatives for Blocked Tear Ducts

A person using eye drops to treat a blocked tear duct

For those who prefer non-surgical alternatives for treating blocked tear ducts, options such as:

  • Balloon catheter dilation: involves inserting a balloon catheter into the tear duct to widen it and facilitate the free flow of tears
  • Medication to treat infection
  • Massage of the lacrimal sac

are available.

Antibiotics may be prescribed to combat infection in the tear ducts, and gentle massage of the area around the tear duct can help facilitate the opening of the duct and promote increased tear flow. These non-surgical alternatives can effectively treat blocked tear ducts for some patients, depending on the severity of the blockage and the underlying cause.

When to Consult an Eye Doctor

Consult an eye doctor for a blocked tear duct if you experience persistent tearing for several days, continuous tearing, or if you notice pus or other irregularities in your tears. Early diagnosis and intervention can help prevent complications and ensure the tear drainage system functions properly, allowing for comfortable and healthy eyes.

If a blocked tear duct is suspected in you or a loved one, seeking an eye doctor’s advice for a proper diagnosis and suitable treatment options is crucial. Timely diagnosis and treatment can significantly affect the patient’s quality of life and overall eye health.


Throughout this blog post, we have explored the causes, symptoms, and treatments for blocked tear ducts. We delved into the anatomy of the tear drainage system and discussed the various surgical and non-surgical treatment options available. Understanding the importance of timely diagnosis and intervention and the potential risks and complications of DCR surgery can help patients make informed decisions about their eye health.

Blocked tear ducts may not be life-threatening, but they can significantly impact a person’s quality of life. By recognizing the symptoms, seeking prompt medical attention, and exploring the available treatment options, individuals can take control of their eye health and lead a more comfortable, tear-free life.

Frequently Asked Questions

How serious is tear duct surgery?

Tear duct surgery is a very common and safe procedure, but it can come with some risks such as infection, bleeding, or problems with anesthesia. Additionally, the tear duct may become blocked again in 10 percent of cases.

How long is recovery from tear duct surgery?

Recovery from tear duct surgery is quick and comfortable, with most patients able to return to work within two weeks.

What is the success rate of tear duct surgery?

The success rate of tear duct surgery is high, typically over 90% for external DCR procedures. However, if the obstruction is in the tiny tear canals on the eyelid, success rates may vary between 50-90%.

Are you put to sleep for tear duct surgery?

You may not need to be put to sleep for tear duct surgery, as the doctor may use packing materials soaked with anesthetics and medicine to help you relax and reduce bleeding.

What does it mean when both eyes are watery?

Watery eyes can indicate something serious, like an eye infection, blocked tear ducts or even a medical condition. Pay attention to environmental factors when your eyes start tearing up suddenly and don’t hesitate to visit your healthcare provider if the issue persists.


Photo graph of Dr. Conlon operating with loops on.

Dr. M. Ronan Conlon started his career in the field of ophthalmology at the same time as the development of refractive eye surgery in Canada. In 1996, he brought laser technology to Canada from Germany, which allowed him to perform laser eye surgery before it was available in the United States. With the establishment of the Conlon Eye Institute, Dr. Conlon has performed more than 40,000 refractive procedures and has advanced his expertise in LASIK and refractive cataract surgery.


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