The tear drainage system begins at the inner corners of the upper and lower eyelids with small raised openings called puncta. From there, tears flow through tiny channels called canaliculi, which open into the tear sac located near the root of the nose. The tears then pass from the tear sac into the nasal cavity through the nasolacrimal duct, which lies within the bony structure of the nose. Altogether, this system is referred to as the tear duct system.
Tears secreted from the lacrimal glands spread over the surface of the eye and are then drained into the nasal cavity through this duct system, aided by an active pumping mechanism that relies on the opening and closing of the eyelids.
If a blockage occurs at any point in the duct system, from the puncta to the lower end of the nasolacrimal duct, tears cannot drain into the nose. Instead, they accumulate in the eye and overflow. Obstructions most commonly occur in the nasolacrimal duct after the tear sac. In such cases, the fluid collected in the tear sac may become infected, leading to discharge with a purulent (pus-like) appearance.
Excessive tears, discharge, and pus-like secretions accumulating on the eye surface can impair the optical quality of vision. Additionally, chronic infection may spread to the eye and cause serious clinical complications. In patients with tear duct obstruction and eye infection, intraocular surgeries (such as cataract surgery) should never be performed until the obstruction is resolved.
The causes vary depending on the site of the obstruction. Chronic surface infections of the eye, certain medications, and radiotherapy may lead to obstruction in the upper ducts (puncta or canaliculi) before the tear sac.
However, obstructions most frequently occur in the nasolacrimal duct after the tear sac, and nasolacrimal duct obstruction is the most common type.
The main symptoms are excessive tearing and eye discharge. Complaints often worsen in cold and windy weather. In some cases, acute attacks may develop, presenting with swelling, redness, pain, and fever around the eye area. Such situations require systemic treatment with appropriate antibiotics.
A definitive diagnosis can be made by performing a lacrimal irrigation procedure. If the fluid introduced through the canaliculi does not pass into the nose, the diagnosis of obstruction is confirmed.
Tear duct obstruction is relatively common in infants. Some babies are born with incompletely opened tear ducts. Persistent tearing and watery eyes in the affected eye are usually sufficient for diagnosis. In these cases, spontaneous opening of the duct is often expected within the first year of life. During this waiting period, antibiotic eye drops may be used to prevent infection, and massage can be applied to help facilitate duct opening.
If the duct does not open on its own, probing of the duct and insertion of silicone tubes may be performed to relieve the obstruction. If these measures are unsuccessful, surgical intervention is usually delayed until around 3–4 years of age.
In adults, treatment is surgical. Depending on the site of the obstruction, a new bypass passage is created to allow tears to drain into the nose. These surgeries are generally performed under general anesthesia.
It is important to note that in adults, tear duct obstruction cannot be corrected with medication alone; surgery is required.
Chronic infection, excessive tearing, and discharge in an eye with tear duct obstruction can significantly impair quality of life. The longer treatment is delayed, the lower the success rate of surgery becomes. Additionally, intraocular surgeries (such as cataract surgery) must never be performed in an eye with active tear duct infection, as this can lead to severe intraocular infections and, in rare cases, even loss of the eye.
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