Tear Duct Surgery

Watery eyes, also known as epiphora, occur when tears are produced in excess or are unable to drain properly. 

A common cause for watery eyes is a blocked tear duct which occurs when something prevents tears from draining normally from the eye. When this happens, tear fluid slows or stops flowing through the tear drainage system and backs up into the eye, causing persistent watering. The medical term for this condition is nasolacrimal duct obstruction.

Tears are essential for healthy eyes. They keep the surface of the eye lubricated, help the cornea absorb oxygen, and contain immune components that protect against infection and support healing.

The tear drainage system works much like the drain on a house. If a drain becomes blocked, water backs up and overflows. In the same way, a blockage in the tear duct causes tears to overflow onto the eye and face.

Symptoms of a blocked tear duct may include:

• Excessive tearing or watery eyes (epiphora)
• Sticky or crusty discharge on the eyelids or eyelashes
• Frequent rubbing of the eye or the area around the duct
• Redness or swelling, often due to irritation or rubbing
• Blurred vision

A blocked tear duct can also increase the risk of infection. Signs of infection may include:

• Redness or swelling over the tear duct or surrounding tissues
• Eye pain or a feeling of sinus pressure
• Redness or irritation of the eyeball, particularly the sclera (white part of the eye)
• Fever
• Fussiness or irritability, especially in infants

A blocked tear duct is very treatable, and in many cases it can be cured. Treatment depends on the person’s age, the cause of the blockage, and how severe it is. In babies, the condition often improves on its own, but treatment is usually recommended to reduce the risk of infection and other complications.

Some treatments, such as antibiotics, may be used at any age if there is an associated infection. These may be prescribed as eye drops or ointments. Your eye care specialist will advise if medication is appropriate in your case.

For babies and infants, the most common treatment is a special tear duct massage that can be done at home. Your child’s paediatrician or eye care provider can show you how to perform this safely and correctly. This massage helps open the blocked membrane and allows tears to drain normally.

In many cases, massage alone is enough to resolve the blockage. If the blockage has not improved by around one year of age, further treatment may be needed. Massage is generally not effective for adults, so different approaches are usually required.

One of the simplest medical treatments for a blocked tear duct is a three-step procedure called dilation, probing and irrigation. This may be used in infants if massage is unsuccessful and is often the first treatment for older children and adults.

The steps include:

• Dilation: The tear duct openings are gently widened to allow access.
• Probing: A fine instrument is used to locate and clear the blockage.
• Irrigation: Saline fluid is flushed through the tear duct to ensure it is open and draining properly.

If probing and irrigation are not enough, balloon dilation may be recommended. This involves inserting a tiny balloon into the narrowed section of the tear duct and gently inflating it to widen the duct from the inside.

When other treatments are unsuccessful or the blockage is severe, surgery may be recommended. The main surgical option is:

• Dacryocystorhinostomy (DCR): Creates a new drainage pathway for tears, bypassing the blocked duct.

The most suitable procedure depends on the type and location of the blockage. Your eye care specialist will discuss the benefits, risks, and expected outcomes with you.

The outlook for blocked tear ducts is generally very good.

• In babies: About 70% improve by six months of age, and around 90% resolve by one year. Massage helps speed recovery and lowers the risk of infection. Congenital blockages usually do not cause long-term problems.
• In adults: Most cases respond well to treatment, especially when caused by injury or inflammation. Your eye care specialist will guide you on the best option and expected outcome.

Blocked tear ducts are not dangerous on their own, but untreated blockages can lead to infections, so prompt assessment and treatment are important.