A swollen tear duct can usually be managed with self-care measures such as warm compresses and massage. Sometimes, however, a swollen tear duct may require antibiotics or surgery in order to heal.
This article explains common causes of swollen tear ducts and how they are diagnosed and treated.
Symptoms of a Swollen Tear Duct
Tear ducts are part of the tear drainage system. They drain tears through the nasal bone and into the back of the nose. When tear ducts are blocked, tears can’t drain normally. As a result, the eyes can become watery, irritated, or repeatedly infected.
Symptoms of swollen tear ducts include:
Redness in the eye and eyelidInflamed eyesIncreased tearing (epiphoria)Discharge from the eyeFever
The tears may be thicker than normal. The eyes can also become dry and crusty.
The symptoms of a blocked tear duct may get worse after a cold or sinus infection. They may also become more noticeable after exposure to the cold, wind, or sunlight.
Common Causes of Swollen Tear Ducts
Most of the time, a swollen tear duct is caused by an infection or a blockage. Here’s more about these causes as well as some less common ones.
Infection
Dacryocystitis, or an infected tear duct, causes excessive tearing, redness, and/or yellow discharge. This infection is unrelated to allergies, a cold, or other underlying conditions.
An infection in adults can be due to the natural growth pattern of the bones that surround the eyes and nose. Sometimes there is abnormal development of the skull and face. Either of these can result in a narrowing of the tear ducts, which allows bacteria to collect and grow.
In severe cases, an infection in the tear duct can spread to the eyelid.
Blocked Tear Duct
Causes of a blocked tear duct include:
Chronic nose infections: Repeated nasal infections, such as chronic sinusitis, can obstruct the tear ducts. Abnormal development of the skull and face: People with certain skull or facial abnormalities, like Down syndrome, are more likely to be affected by a blocked tear duct. Age-related changes: Changes like narrowing of the punctal openings, tiny openings in the inner eyelid, can cause blocked tear ducts. Trauma to the nose: In injuries to the nose, such as a broken nose, scar tissue can block the tear duct. Nasal polyps: Polyps are growths in the lining of the nose (affecting some people who have nasal allergies) that can obstruct the tear duct system. Conjunctivitis: This is inflammation of the conjunctiva, the mucus membrane lining the inner surface of the eyelids and the front of the eye. In some cases, conjunctivitis may cause tearing due to the inflammation. Tumors: These may press on the tear duct itself and prevent drainage.
Approximately 20% of newborns are born with a blocked tear duct, but the condition usually goes away on its own within four to six months.
Other Causes
Some medical treatments, including radioactive iodine for thyroid conditions and certain chemotherapy drugs, can also cause swollen tear ducts. Radiation to your face or head may increase the risk of developing a blocked tear duct.
Excessive use of certain eye drops for treating glaucoma can also lead to blocked ducts.
When to See a Healthcare Provider
It’s important to know when to reach out to an ophthalmologist if you are having symptoms of a swollen tear duct. You should notify a healthcare provider if:
Watery eyes interfere with everyday activities. Your eyes are watery all the time. You have frequent eye infections. Your eyes are constantly irritated. Traces of blood appear in the tears. You have a fever. There is redness, swelling, and/or pain in the area between the eye and the nose. Changes occur in your vision, including blurry vision, double vision, or light sensitivity.
Diagnosis
An ophthalmologist can diagnose a swollen tear duct based on a physical examination and diagnostic tests. You will be asked to provide a full medical history. Your provider will examine the eye and surrounding areas. They might also perform or order certain tests, such as:
Tear drainage test: This test measures how quickly your tears are draining. One drop of a special dye is placed on the surface of each eye. If the drop is still on the surface of the eye after five minutes, this could indicate a swollen or blocked tear duct. Eye imaging tests: Contrast dye is passed from the corner of your lid through your tear drainage system. Then either magnetic resonance imaging (MRI) or a computed tomography (CT) scan is done of the area. Irrigation and probing: A saline solution is flushed through your tear drainage system to check how well it’s draining. A probe is inserted through the tiny drainage holes at the corner of your lid (called puncta) to check for blockages.
Treatment
Treating a swollen tear duct can often ease symptoms like tearing, pain, and redness. Treatments can widen or bypass a blocked tear duct to help tears drain normally again. There are things you can do at home to unblock the duct. In some cases, however, surgery or procedures to open the ducts may be necessary.
Self-Care
The easiest method for treating a swollen tear duct is through massage and warm compresses. To unblock your tear ducts at home, you will need warm water (not hot) and a clean washcloth:
Pinch and rub your nose underneath the bridge. Place a warm, wet cloth over your eyes for 10 minutes. Repeat every four to six hours as needed.
This should cause a clear fluid to drain out of the corners of your eyes. The pressure normally causes tears to flow through the puncta, thus preventing infection. This does not always work but is the best option when waiting for a medical appointment.
Antibiotics
If massage and warm compresses do not clear the tear duct, then a healthcare provider may prescribe antibiotic eye drops or ointment. Antibiotics won’t open the blockage, but they can treat an infection and clear up any discharge coming from the eye. Chronic infections, however, can be difficult to cure without surgery to expand the tear duct’s drainage channel.
In severe cases, people with a tear duct infection may need intravenous antibiotics and observation in the hospital.
Dilation, Probing, and Irrigation
For adults who have a partially blocked duct or a partial narrowing of the puncta, this technique may be used. An instrument is used to enlarge the punctal openings, and a narrow probe is guided through the puncta, into the tear drainage system, and then through the nasal opening before being removed. The tear drainage system is flushed with a saline solution to clear out any residual blockage.
Balloon Catheter Dilation
A balloon catheter dilation procedure opens tear drainage passages that are narrowed or blocked by scarring or inflammation. Your doctor will pass a thin wirelike probe of about 2–3 mm (millimeters) wide with an inflated balloon on the tip through the blocked tear duct and into the nasal cavity. Then they will inflate and deflate the tiny balloon with a sterile saline solution several times to open the blockage and expand the tear duct. This is done under general anesthesia.
Stenting
In this procedure, also called tear duct intubation, tiny tubes are used to open narrow passageways within the tear drainage system. Your doctor guides a metal mesh tube (a stent) through one or both puncta in the corner of your eye, through the tear drainage system, and into the back of the nose. A tiny loop of tubing is left in the tear duct. While it may be visible, it’s usually not bothersome.
These tubes are generally left in for three to four months and then removed. This approach also requires general anesthesia.
Surgery
Surgery may be required if other treatment options are not working. This surgery is called dacryocystorhinostomy (DCR) surgery, also referred to as lacrimal sac surgery.
DCR is one of the most common eye surgeries performed on adults. It creates a new route for tears to drain from the eye. Sometimes the new opening totally bypasses the tear drainage system and lets tears flow straight into the nose.
This surgery is performed on adults only when no other treatments have worked. It is rarely performed on children. The surgery can be done under general anesthesia or local anesthesia. After the procedure, you may be given topical steroids, nasal medications, and pain medication.
It is important to discuss with the surgeon which technique they will be using, as recovery times and post-operative care differ. Two surgical techniques include:
External: The surgeon makes a small cut on the side of your nose, which they close with stitches. Intranasal/endoscopic: The surgeon inserts tiny instruments and a camera through the opening of your nose. This type of surgery causes less pain than external surgery, and it doesn’t leave scars.
As with all surgical procedures, there are potential risks and complications. Your surgeon will discuss these with you beforehand. Possible complications include:
Excessive bleedingInfectionFacial scarDislodging of the stent (a tube placed during surgery to keep the duct open)Nasal congestion or nosebleedsWatery eyes
At your first appointment after the surgery, any stitches will be removed. Oral medications and topical steroids will be discontinued, but you’ll likely take nasal medications for two more weeks. You may have follow-up appointments at six weeks, 12 weeks, and finally at six months.
Summary
Tear ducts allow tears to drain from the eye into the nose. A swollen tear duct can result from an infection or a blockage.
Symptoms of a swollen tear duct include excessive tearing, eye discharge, chronic nasal infections, or injury. Self-care measures such as warm compresses are often effective for unblocking the duct. If they don’t work, then antibiotics or minor surgery may be necessary.
A Word From Verywell
A swollen tear duct can be uncomfortable but is manageable when treated early. Call your doctor right away if your eyes are so watery that it interferes with your daily activities, you have a fever along with a swollen duct, or you are having vision problems.
