Normal Tear Production and Drainage Mechanism 

Tears are essential for eye health, providing lubrication, nutrients, and protection against pathogens. Tears are produced primarily by the lacrimal gland located under the upper eyelid.  

Once tears are produced, they spread across the surface of the eye with each blink. Excess tears then drain through tiny openings called puncta, located at the inner corner of each eyelid, into small channels known as canaliculi. These canaliculi merge to form the lacrimal sac, and finally empty into the nasal cavity or back of the throat.  

Importance of Normal Tear Drainage 

The efficient drainage of tears is essential for preventing eye irritation, maintaining optimal vision, and promoting overall eye health. When any part of the drainage system is blocked or compromised tears can overflow onto the cheeks causing irritation of the delicate eyelid skin. Stagnant tears can provide a breeding ground for bacteria and increase the risk of eye infections. 

Causes of Blocked Tear Ducts 

A blocked tear duct can result from various factors, including congenital issues, injury, infections, or age-related changes. This includes narrowed tear duct openings, compression or more rarely, the presence of a nasal bone spur or growth.  

In newborns, blocked tear ducts often result from a congenital condition where the tear duct fails to fully open during development. The nasolacrimal duct may have a partial obstruction or membrane causing tears to accumulate.

Symptoms 

When the tear ducts are blocked, tears have no where to drain often causing:  

• Excessive tearing 

• Sticky discharge 

• Eye Irritation 

• Crusty eyelids 

• Recurring eye infections 

Diagnosis 

Blocked tear ducts can be diagnosed through a clinical examination by an eye care professional.  

The most common diagnostic method is called tear duct probe and syringing. During this test, a small probe is inserted into the puncta, then saline solution is flushed through the tear duct to check how well it is draining. In some cases, this may help clear the blockage and provide temporary relief or even fix the problem. 

Treatment 

Treatment will depend on the cause of the blocked tear duct.  

Treatment options include:  

• Warm compress and massage – to relieve symptoms and promote tear drainage. 

• Antibiotics – topical or oral, to treat any infection if present. 

• Punctoplasty – A minor procedure used to widen the punctal opening when tear drainage is reduced due to punctal stenosis (narrowing of the tear duct opening).  

• Dacryocystorhinostomy (DCR) – A surgical procedure used to create a new drainage pathway for tears.