Clear a Blocked Tear Duct

If your eye is watery and inflamed, you might have a blocked tear duct. Blocked tear ducts can occur as the result of an infection or something more serious, like a tumor. It's usually possible to treat a blocked tear duct using massage, but if further treatment is necessary, your doctor may prescribe antibiotics or recommend surgery to unblock the duct.

Steps

Diagnosing a Blocked Tear Duct

1. Know what causes a blocked teardrop. A blocked tear duct (also known as dacryocystitis) happens when there is an obstruction in the passageway that connects the eyes to the nose. This is most common in newborn babies, but it can also happen to adults as a result of infection, injury or tumor. Here are the common causes:
   • Congenital blockage, which happens often in newborns
   • Age-related changes
   • Infections in the eye
   • Trauma to the face
   • Tumors
   • Cancer treatments
2. Recognize the symptoms of a blocked tear duct. The most common symptom is increased tearing in the eye. These tears may overflow to the face. When suffering from a blocked tear duct, tears may be a little bit thicker than normal and crust over as they dry. Other symptoms include:
   • Recurrent eye inflammation
   • Blurred vision
   • Mucus or pus-like discharge in the eye lids
3. See your doctor for a diagnosis. Physical examination by a medical professional is required in order to diagnose a blocked tear duct. While simple inflammation might be causing the blockage, it could also be a tumor or another serious medical problem, so it's important to see your doctor.
   • To test for a blocked tear duct, the doctor will flush out the eye using a dyed liquid. If the tears do not flow normally, and you can taste the liquid and feel it dripping down the back of the throat, this is a good indication that there is a blockage in the tear ducts.
   • The doctor will also ask you to describe your symptoms, which are of great clinical value as they can help to rule out other eye conditions like congenital conjunctivitis and glaucoma.

Clearing a Blocked Tear Duct at Home

1. Cleanse the area often. Use a clean washcloth and warm water to wipe away the drainage several times a day, so it doesn't interfere with vision. This is especially important if the drainage is being caused by an infection that could spread to the other eye.
2. Apply a warm compress to promote drainage. A warm compress can open it up and allow it to drain more easily. Press the warm compress against the top of the tear duct for three to five minutes, up to five times a day until the blockage clears.
   • To make a warm compress, you can use a warm, damp towel or dip a cotton ball in warm water or chamomile tea (which has soothing properties).
   • Make sure the warm compress isn't too hot, or it could cause redness and pain.
3. Try lacrimal sac massages to unblock the duct. Lacrimal sac massage can be used to open up the tear duct and encourage drainage. Your doctor may show you how to perform this massage on yourself or on your baby to clear a tear duct. To perform the massage, place the index fingers at the inner corners of the eyes, close to the sides of the nose.
   • Apply pressure to this spot for several seconds, then release. Repeat this 3 to 5 times per day.
   • Always remember to wash your hands before performing a lacrimal sac massage, as you don't want to risk introducing bacteria to the eyes and causing an infection.
4. Place breast milk in the eyes to kill bacteria. This method is effective for babies with blocked tear ducts. Breast milk contains antimicrobial properties that help to fight off infection in the blocked tear duct, while also lubricating the eye and minimizing irritation.
   • Place a few drops of breast milk onto your index finger, then allow it to drip into the baby's affected eye. You can do this up to six times per day.
   • Again, it's very important that you wash your hands thoroughly before doing this, to avoid introducing bacteria to the baby's eyes.

Undergoing Medical Treatment

1. Take oral antibiotics to fight tear duct infection. Oral antibiotics will be prescribed to help with the blocked tear duct if the cause of the blocked duct is infection. Antibiotics are substances that are used to inhibit the growth of bacteria in a specific area of the body.
   • Erythromycin is the most common drug used for a blocked tear duct. This drug prevents bacteria from growing and multiplying, by interfering with the bacteria's protein-making cycle.
   • The usual dosage of erythromycin is one 250mg tablet four times daily. However, this will vary according to the severity of the infection and the age of the patient, so follow your doctor's instructions.
2. Use antibiotic eye drops instead of oral medications. For less serious infection, antibiotic eye drops are sometimes prescribed instead or oral antibiotics.
   • To use the eye drops, shake the bottle well, tilt your head back, then place the recommended number of drops into the eye. Close the eye for 30 seconds to a minute to allow the eye drops to be absorbed.
   • Always wash your hands before using eye drops to avoid introducing bacteria to the eye. After applying the eyes drops, wash the hands again.
   • For children, the instruction is the same, but the assistance of another adult will be needed to prevent the child from moving.
3. Have the blocked tear duct probed and irrigated. Dilation, probing and irrigation is a minimally invasive treatment that can also be done to clear a blocked tear duct. This procedure is done under general anesthesia and takes about 30 minutes.
   • The procedure is performed by dilating the puncta (the two little holes in the eyelid) with a tiny metal dilating tool. After that, a probe is moved through the passage way until it reaches the nose. When the probe reaches the nose the passage is irrigated using a sterile liquid.
   • If you (or your child) are set to receive this treatment, it's important that you avoid taking aspirin or ibuprofen in the two weeks before the surgery, as it could lead to bleeding.
4. Consider intubation treatment. Intubation is another minimally invasive treatment option. Similar to probing and irrigation, its goal is to open the blockage in the tear duct. General anaesthesia is given to the patient to make him or her sleep.
   • During the procedure, a thin tube is then inserted through the tear sac at the corners of the eyes until it reaches the nose. This tube is then left in the duct for three to four months to allow the tear duct to drain and prevent it from getting blocked again.
   • The tube itself is barely noticeable, but after the surgery certain precautions must be taken to prevent infection. You must avoid rubbing your eyes in case you move or damage the tube and you must always remember to wash your hands before touching your eyes.
5. Undergo surgery as a last resort. Surgery is the last treatment option. When the tear duct cannot be unblocked using one of the methods described above, it needs to be removed entirely in a procedure known as a dacryocystorhinostomy.
   • A dacryocystorhinostom is done by creating a bypass communication between the tear duct and the nose, which allows the tears to drain.
   • A fistula is then inserted in the duct, serving as the passage way of the tears.

Tips

• Most babies are born with a dacryocystitis (blocked tear ducts), but they usually get better on their own after a few months, when the tear duct drainage system matures.

Sources and Citations

• Cohen NA, et al. Prevention and management of lacrimal duct injury. Otolaryngology Clinics of North America. 2010;43:781.
• Davis H, Mant D, Scott C et al.; Relative impact of clinical evidence and over-the-counter prescribing on topical antibiotic use for acute infective conjunctivitis. British Journal of General Practice, Volume 59, Number 569, December 2009.
• Kanski J. Clinical Ophthalmology, A Systematic Approach, 5th Ed, 2003, Butterworth Heinemann
• Kunimoto DY, Kanitkar KD, Makar MS; The Wills Eye Manual, 4th Edition, 2004, Lippincott, Williams and Wilkins
• Nasolacrimal duct obstruction. American Association for Pediatric Ophthalmology and Strabismus. http://www.aapos.org/terms/conditions/72.

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