Causes and Treatments for Swollen Tear Duct

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Tear ducts are part of the tear drainage system of the eye. They can become swollen due to an infection or a blockage.

A swollen tear duct is usually able to be managed through non-invasive options, such as warm compresses and massage, as well as antibiotics or surgical options. Speak with your healthcare provider to determine the best treatment option.

Close-up of eye

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What Is a Swollen Tear Duct?

The tear duct, also called the nasolacrimal duct, is part of the tear drainage system. It drains tears through the nasal bone and into the back of the nose. A swollen tear duct is likely the result of a blocked or infected tear duct.

If blocked, the duct can be either partially or completely obstructed, and tears can't drain normally. As a result, it can cause a watery, irritated, or chronically infected eye.

If you are concerned that you have a swollen tear duct, your eye will typically have eye and eyelid redness, eye inflammation, and excessive tearing. Other symptoms may include fever and eye discharge. In severe cases, an infection can spread to the eyelids.

Common Causes of Swollen Tear Duct

There are several reasons you may have a swollen tear duct. The most significant reasons are due to infection, or dacryocystitis, or as a result of a blocked tear duct.

Other causes include chronic nose infections, abnormal development of the skull and face, age-related changes, nose trauma, nose polyps, repeated use of certain eye drops for treating glaucoma, conjunctivitis, and/or tumor.

Some cancer treatments, including radioactive iodine for thyroid conditions and certain chemotherapy drugs, can also cause swollen tear ducts. Radiation and/or chemotherapy to your face or head may increase the risk of developing a blocked tear duct and needing intervention.

A baby can be born with a blocked tear duct (a congenital blocked tear duct). Approximately 20% of newborns are born with a blocked tear duct, but the condition usually resolves without intervention within four to six months.

Infection

Dacryocystitis, or infected tear duct, is an infection and inflammation of the eye's tear drainage system. As a result, you may suffer from excessive tearing, redness, and/or yellow discharge. This infection occurs when there is no presence of allergies, a cold, or other underlying or co-existing conditions.

Infection occurs in adults due to the surrounding bones' natural growth pattern, resulting in a narrowing of the tear ducts. This allows for bacteria to collect and grow. On the other hand, infants are born with a membrane covering the tear duct that may not open or is too narrow for tears to pass.

Blocked Tear Duct

A blockage may occur at any point in the lacrimal drainage system. Causes of a blocked tear duct include:

When to See a Doctor

Constantly having watery, red, and/or itchy eyes can be concerning. It's important to know when to reach out to an ophthalmologist. Adults experiencing any of the symptoms related to a swollen tear duct should notify a healthcare provider if:

  • Watery eyes are interfering with everyday activities
  • Eye(s) are watery all the time
  • Frequent eye infections
  • Eye(s) are constantly irritated
  • Traces of blood in the tears
  • Fever
  • Experience redness, swelling, and/or pain in the area between the eye and the nose
  • Changes in vision including blurry vision, double vision, light sensitivity

Diagnosis

An ophthalmologist will diagnosis a swollen tear duct through a physical examination and diagnostic tests. A full medical and physical history will be made as well as a complete physical examination of the eye and surrounding areas:

  • Tear drainage test: This test measures how quickly your tears are draining. One drop of a special dye is placed on the surface of each eye. If the drop is still on the surface of the eye after five minutes, this could indicate a swollen or blocked tear duct.
  • Eye imaging tests: Contrast dye is passed from the puncta in the corner of your lid through your tear drainage system. Then either magnetic resonance imaging (MRI) or a computed tomography (CT) scan is done of the area.
  • Irrigation and probing: A saline solution is flushed through your tear drainage system to check how well it's draining. A probe is inserted through the tiny drainage holes at the corner of your lid (puncta) to check for blockages.

Treatment

Treating a swollen tear duct can often ease symptoms like tearing, pain, and redness. Treatments can widen or bypass a blocked tear duct to help tears drain normally out of your eye again. There are noninvasive options like massage and warm compresses and the most invasive option—surgery.

Self Care

The least invasive method to treating a swollen tear duct is through warm compresses and massage. To unblock your tear ducts at home, you will need warm water, not hot, and a clean washcloth:

  1. Pinch and rub your nose underneath the bridge.
  2. Place a warm, wet cloth over your eyes for 10 minutes.
  3. Repeat every 4 to 6 hours, if needed.

This should cause a clear fluid to drain out of the corners of the eyes. The hydrostatic pressure normally causes reflux of the mucus and tears through the puncta, thus preventing superinfection in the tear sac. This does not always work but is the best option when waiting for a medical appointment.

Children born with a blocked tear duct usually get better without treatment within four to six months.

Antibiotics

If massage and warm compresses do not clear the tear duct, then a professional healthcare provider may prescribe antibiotic eye drops or ointment.

Antibiotics won't open the blockage, but they can treat an infection and clear up any discharge coming from the eye. It's important to note that symptoms will recur when antibiotics are discontinued.

Surgery

Surgery may be required if the swollen tear ducts are not resolved through other treatment options. Surgical options include dacryocystorhinostomy (DCR) surgery also referred to as lacrimal sac surgery.

Dacryocystorhinostomy

Dacryocystorhinostomy is one of the most common eye surgeries performed on adults, creates a new route for tears to drain from the eye. Sometimes the new opening totally bypasses the tear drainage system and lets tears flow straight into the nose. It may be performed with an external skin incision or intranasally (endoscopic).

This surgery is only performed on adults when no other treatments have worked. It is rarely performed on children. The surgery can be done under general anesthesia or local anesthesia. After the procedure, you will be started on oral antibiotics and analgesics or pain medication.

At your first postoperative appointment, the sutures are removed, oral medications are discontinued, topical steroids are tapered, and nasal medications are continued for two more weeks. You will have follow-up appointments at six weeks, 12 weeks, and finally at six months.

It is important to discuss with the surgeon which technique they will be using as recovery times and post-operative care differ. Two surgical techniques include:

  • External: The surgeon makes a small cut on the side of your nose, which they close with stitches.
  • Intranasally/endoscopic: The surgeon inserts tiny instruments and a camera through the opening of your nose. This type of surgery causes less pain than external surgery, and it doesn't leave scars.

As with all surgical procedures, there are potential risks and complications. Your surgeon will discuss these with you pre-operatively. Possible complications include:

  • Excessive bleeding
  • Infection
  • Facial scar
  • Dislodging of the stent (a tube placed during surgery)
  • Nasal congestion or nosebleeds
  • Recurrent tearing

A Word From Verywell

A swollen tear duct can be uncomfortable but is manageable with early intervention. It is likely the result of a blocked or infected tear duct. Starting with warm compresses and massage can help alleviate the problem before surgery is possibly needed. It's vital to discuss with your healthcare provider all possible options.

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Article Sources
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