Tear duct obstruction is a significant condition that negatively affects eye health and can seriously impact quality of life. As an Ophthalmology Specialist, I frequently encounter this issue in my practice. Tear ducts are part of the nasolacrimal system, which drains tears from the eyes into the nasal cavity. When these ducts become blocked, tears cannot drain properly, leading to symptoms like persistent eye watering, discharge, blurred vision, and sometimes infections. Tear duct obstruction can occur in both infants and adults, but it most commonly presents in infants due to congenital reasons.
Tear Duct Obstruction in Infants: A Congenital Issue
In infants, tear duct obstruction usually occurs because a thin membrane (Hasner’s valve) at the lower end of the duct fails to open after birth, blocking tear flow. Parents often bring their babies to the clinic with complaints of constant tearing, discharge, and eyelashes sticking together after sleep. This condition affects about 5–20% of newborns and often resolves spontaneously within the first year.
During this period, I recommend parents perform regular and proper lacrimal sac massage. Massage should be applied gently to the inner corner of the eye with a downward pumping motion; this helps open the membrane at the end of the tear duct. If needed, antibiotic eye drops prescribed by a doctor can also be used.
When Is Probing Necessary?
If massage does not resolve the issue or if infections recur frequently, probing, usually between ages 1–2, becomes necessary. This procedure involves inserting a thin probe into the tear duct to mechanically open the blockage. Performed under sedation or light anesthesia, it is a short and painless procedure for the baby, and it provides a permanent solution in most cases.
Ritleng Method: Silicone Tube Insertion
In cases of severe duct narrowing or recurrent blockage after initial probing, the Ritleng method—silicone tube insertion—is preferred. A thin silicone tube is inserted from the tear duct into the nasal cavity and left in place for about 3–6 months to keep the duct open during healing. After the tube is removed, most children achieve permanent resolution. The Ritleng method significantly increases success rates, especially in complex cases.
Tear Duct Obstruction in Adults and DSR Surgery
In adults, tear duct obstruction often develops due to chronic inflammation, trauma, age-related narrowing, or certain systemic diseases. Massage or probing is ineffective in adults; surgical intervention is usually required for a definitive solution. Dacryocystorhinostomy (DSR) surgery creates a new pathway between the lacrimal sac and the nasal cavity, allowing tears to drain properly. This surgery can be performed using open, endoscopic, or laser techniques, and it has a high success rate, providing permanent relief of symptoms.
DSR surgery is rarely required in children but may be considered in complex congenital cases diagnosed late or when silicone tube treatment fails.
Risk of Infection in Tear Duct Obstruction
If left untreated, tear duct obstruction can lead to tear stagnation, creating an ideal environment for bacteria to multiply. This can result in dacryocystitis—an infection of the lacrimal sac—characterized by swelling, redness, severe pain, and fever around the eye. Dacryocystitis requires urgent treatment with antibiotics and sometimes emergency surgical drainage. Repeated infections can cause permanent tissue damage.
Recommendations for Patients with Tear Duct Obstruction
✅ In infants, be patient during the first year and perform regular massage with the correct technique.
✅ If discharge increases, use antibiotic eye drops as prescribed by your doctor.
✅ If tearing persists beyond one year, consult your eye doctor for evaluation and possible probing.
✅ In adults, persistent tearing, discharge, or a sensation of irritation in the eye should raise suspicion for tear duct obstruction; early diagnosis and treatment help prevent permanent damage.
Conclusion: Don’t Ignore Chronic Tearing
Tear duct obstruction may seem like a minor issue, but it can be a sign of a more serious underlying problem. With proper diagnosis and timely treatment, permanent solutions are often possible. Remember:
"Chronic tearing should never be ignored; consult your eye doctor early to protect your vision and eye health."
Op. Dr. Gökhan ÖZGÜR
Ophthalmology Specialist
Medicana International Samsun Hospital
