What Is a Blocked Tear Duct in Adults?

Adults come in because one eye waters all the time and runs over in wind or cold, tears streak the cheek, and the eye may be gummy or crusted, especially on waking. Some notice a tender swelling by the side of the nose. It is not just an annoyance — the constant wiping, blurring, and social awkwardness lead people to ask what is actually blocking the tears and whether it can be fixed.

Tears normally drain through small openings at the inner corners of the lids, into the tear sac, and down the nasolacrimal duct into the nose. When that duct is narrowed or blocked, tears have nowhere to go and spill over the lid.

Because tears also pool in the tear sac above the blockage, the stagnant fluid can become infected, producing the tender, red, swollen lump of dacryocystitis. Chronically, the eye feels wet and irritated and vision can blur between blinks as the tear film destabilizes. The eye itself is usually healthy; the problem is plumbing rather than the eye's ability to see.

In adults, nasolacrimal duct obstruction is most often primary and acquired — the duct narrows gradually with age, more commonly in women. Secondary causes include chronic inflammation, prior severe or repeated infections, nasal and sinus disease, previous facial trauma or fractures, scarring, certain medications and radiation, and, uncommonly, a tumor in the tear sac or nose. A newly blocked duct with bloody tearing or a mass warrants closer evaluation to exclude a growth.

The blockage can be partial or complete and can sit at different levels — at the drainage openings (punctal or canalicular narrowing) or lower in the duct. Stagnant tears predispose to dacryocystitis, which can be acute (sudden painful red swelling) or chronic (recurrent mattering and mild swelling). Because tearing has several look-alike causes — dry eye, ectropion, lid laxity, punctal stenosis — confirming that the obstruction is genuine, and locating it, guides the right treatment.

A blocked duct is usually not dangerous, but seek prompt care if you develop:

• A red, swollen, tender lump at the inner corner near the nose, with or without fever (dacryocystitis)
• Pus or thick discharge, spreading redness, or increasing pain
• Bloody tears, or a visible mass in the inner corner (needs evaluation to rule out a tumor)
• Fever or swelling spreading toward the cheek or eye socket, which can signal a deeper infection

An acute tear-sac infection can spread and should not be left untreated.

The doctor first confirms the tearing is from poor drainage rather than surface irritation or lid position. The drainage openings are inspected, and the system is often gently irrigated (and sometimes probed) to confirm and localize a blockage; a dye disappearance test can show whether tears clear normally. If the sac is swollen, the doctor checks for infection. When a tumor or unusual cause is suspected — bloody tearing, a mass, or an atypical one-sided blockage — imaging such as CT or a dacryocystogram may be ordered. The goal is to prove the duct is truly blocked, find where, and rule out a serious cause before recommending surgery.

For a partial blockage or narrowed openings, conservative measures may help: treating any infection with antibiotics, warm compresses and massage over the tear sac, and in-office punctal dilation. An acute tear-sac infection is treated first with antibiotics before any surgery.

For a genuinely obstructed nasolacrimal duct causing bothersome tearing or recurrent infection, the definitive treatment is dacryocystorhinostomy (DCR) — a surgery, done externally or endoscopically through the nose, that creates a new opening from the tear sac directly into the nose and bypasses the blockage. In selected partial blockages, balloon dilation or stenting may be options. The right choice depends on where the blockage is and whether infection has been a problem.

• Do not squeeze or repeatedly press a red, painful inner-corner lump; a tear-sac infection needs antibiotics, not squeezing.
• Do not assume constant tearing is always a blocked duct — dry eye and lid laxity mimic it, so get it confirmed.
• Do not ignore bloody tears or a growing lump at the inner corner; these need evaluation to exclude a tumor.
• Do not repeatedly use leftover antibiotic drops hoping to clear a blockage; drops do not open a blocked duct.
• Do not delay care if swelling spreads toward the eye or cheek or you develop a fever.

Call May Eye Care Center if one eye waters constantly, runs over onto the cheek, or is repeatedly sticky, and we can irrigate the drainage system to confirm whether the duct is truly blocked and discuss reopening it. Seek urgent care for a red, painful, swollen inner-corner lump, spreading facial swelling, or fever, which suggest a tear-sac infection. Patients across the Hanover area are welcome to schedule an evaluation.

A blocked tear duct in adults means the nasolacrimal drainage channel is obstructed, causing constant tearing and sometimes infection; once confirmed, it is usually corrected with a bypass surgery called DCR.