Blocked Tear Duct: Causes and Solution

Constant tearing, medically known as epiphora, is one of the most frequent consultations at our lacrimal surgery practice in Malaga and Marbella. Many people live with this problem for years thinking it is "normal" or inevitable, when in fact it has a solution. In this article, I explain the causes of blocked tear ducts and how we can resolve them.

How the lacrimal system works

To understand tear duct obstruction, it is important to know how the tear drainage system functions. Tears are continuously produced by the lacrimal gland, situated in the upper outer part of the eye socket. These tears serve essential functions: they lubricate the eye surface, protect it from external agents and contribute to clear vision. After bathing the ocular surface, tears are collected by two small openings called lacrimal puncta, located on the inner edge of the upper and lower eyelids. From these points, tears flow through the lacrimal canaliculi to the lacrimal sac, a small pouch located between the eye and the nose. Finally, from the lacrimal sac they descend through the nasolacrimal duct to drain into the nasal cavity, beneath the inferior turbinate. When any point along this drainage pathway becomes blocked, tears cannot drain properly and accumulate in the eye, producing the constant tearing that prompts the patient to seek consultation.

Causes of obstruction

Primary acquired obstruction

This is the most frequent cause in adults. It results from chronic inflammation of the nasolacrimal duct leading to progressive narrowing and eventual complete closure. This process is usually idiopathic (without identifiable cause), although it is more frequently associated with middle-aged and older women.

Anatomical and nasal factors

Certain nasal conditions can contribute to tear duct obstruction. Deviated nasal septum, turbinate hypertrophy or nasal polyps can compromise the nasolacrimal duct opening into the nasal cavity, hindering tear drainage.

Infections and dacryocystitis

Duct obstruction can be complicated by infection of the lacrimal sac, known as dacryocystitis. This presents as painful, reddened swelling in the area between the eye and nose, which may be accompanied by purulent discharge. Acute dacryocystitis requires urgent antibiotic treatment and, once the acute phase resolves, definitive surgical treatment.

Congenital causes

In newborns, congenital nasolacrimal duct obstruction is relatively common, affecting up to 6% of neonates. In most cases, it resolves spontaneously during the first year of life. If it persists beyond one year, lacrimal duct probing may be required.

Other causes

Facial trauma, previous nasal surgery, prolonged use of certain ophthalmic medications, facial radiotherapy and, in rare cases, tumours of the lacrimal region can also cause duct obstruction.

Symptoms that should alert you

The main symptoms of tear duct obstruction include:

If you experience any of these symptoms persistently, it is advisable to consult a specialist. At our practice in Malaga and Marbella, we have the experience and equipment necessary to diagnose and treat these problems.

Diagnosis

Diagnosis of tear duct obstruction is made through detailed clinical evaluation and specific tests. At the consultation, Dra. Fanjul performs an ophthalmological and lacrimal pathway examination that includes the lacrimal irrigation test, in which saline solution is introduced through the lacrimal puncta to verify the patency of the drainage system. Additionally, a dacryocystography (radiological study with contrast of the lacrimal pathway) or nasal endoscopy may be performed to evaluate the state of the nasal cavity and the nasolacrimal duct opening.

Treatment: dacryocystorhinostomy

When obstruction is complete and conservative treatment is not effective, the definitive solution is dacryocystorhinostomy (DCR), a surgery that creates a new communication between the lacrimal sac and the nasal cavity, allowing tears to drain correctly without passing through the obstructed duct. Dra. Fanjul performs this procedure via an endoscopic endonasal approach, a minimally invasive technique performed through the nose, without external incisions or visible scarring. This technique, which combines specialisation in otolaryngology and lacrimal surgery, offers a success rate exceeding 90% and rapid recovery.

Prevention and care

Although it is not always possible to prevent tear duct obstruction, there are some measures that can help. Maintaining good ocular hygiene, treating eye infections and nasal conditions that may contribute to the problem early, and seeking review at the first symptoms of abnormal tearing. If you suffer from constant tearing and reside in Malaga, Marbella, Estepona or anywhere on the Costa del Sol, do not hesitate to request an evaluation. Chronic tearing has a solution and Dra. Fanjul can help you recover the visual comfort you deserve.