In order for the eye to stay healthy, it must remain moist. The lacrimal gland, a specialized structure located under the outer one third of the upper eyelid, helps to make tears. Each time you blink, your eyelid spreads tears over the surface of the eye and pumps excess tears towards ducts in both the upper and lower eyelids. These ducts then drain the tears into your nose.


Lacrimal Obstruction is usually due to an infection with the "tear pipe" located in the nose, causing swelling in the inner corner of the eyelid. Approximately seven percent of infants are born with a congenital obstruction of their tear drainage system (the lacrimal duct) in either one or both eyes. This percentage is even higher in premature babies. In most infants, the obstruction is caused by a membrane at the base of the tear duct just before the duct enters the nose.


Obstruction of the tear duct will cause tearing or watering of the eye because the tears cannot drain properly. Symptoms of a blocked tear duct include eyelashes that are stuck together by mucous or an accumulation of tears in one or both eyes. The tears trapped within the duct may become infected, causing a painful swelling in the inner corner of the eyelid.


It is important that excessive tearing or discharge be examined by an ophthalmologist to determine the cause of the problem. In some children, excessive tearing may be due to causes other than tear duct obstruction. In infants the membrane that causes the obstruction will usually open on its own within three to four weeks after birth. If this does not occur, your physician will recommend treatment to open the blockage.


Initial treatment involves massaging the area over the affected tear sac (located under the skin between the eye and nose) to force the tears and mucous from the sac, hopefully pushing open the membrane causing the obstruction. In infants this massage requires the active involvement of the parent, as it must occur frequently. Massage is generally continued until the tearing resolves. Antibiotic drops or ointments may also be prescribed by the physician.

If the obstruction is still present, it may be necessary to open the tear duct by probing and irrigation. In infants this is most commonly performed between six months and one year of age. The probing is done by passing a thin probe down the tear drainage system in an attempt to open the blockage. There is minimal pain associated with this procedure. After the probing, there may be some brief blood staining of the tears or a slight nosebleed. Antibiotic drops or ointments may be prescribed. Unfortunately, blockages may recur in spite of probing. If the tearing persists, then a silicone tube may be paced down the duct to keep the tear draining system open. The tubes are tiny and generally imperceptible and usually remain in place for twelve months to prevent the obstruction from recurring.


Treatment depends on the exact cause. If the tear drainage system in blocked, surgery to open the blockage may be necessary. The type of surgery depends on the location of the blockage. For example, it may be necessary to make an additional opening from the lacrimal sac into the nose, a procedure known as a dacryocystorhinostomy or DCR. If the problem is dry eyes, artificial tear replacement or even closure of the tear drainage (puncta) may be helpful.