CONDITION / FACE

Obstruction of lacrimal ducts.

Obstruction of the lacrimal ducts is a blockage of the duct through which tears flow from the eye to the nose. Because of it, the eye constantly tears, and inflammation in the lacrimal sac can begin - dacryocystitis. Obstruction in babies often goes away on its own, and in adults, obstruction is treated with surgery.

Discuss your case How it is treated in the clinic ↓

CONCEPTUAL VISUALIZATION

OVERVIEW

What it is: Blockage of the path through which tears flow from the eye to the nose; inflammation of the lacrimal sac - dacryocystitis.
In babies: It occurs in 5–20% of young children and often resolves without surgery.
When urgent: The swelling has spread to the eyelids, the eye protrudes, doubles or sees worse - 103.
Basic operation: Dacryocystorhinostomy is a new opening between the lacrimal sac and the nose.

01 / WHAT IS IT

What is
obstruction and dacryocystitis.

Tears constantly wash the eye and then drain through tiny openings on the edges of the eyelids near the inner corner of the eye into the lacrimal sac and from there through the nasolacrimal duct into the nose. If the duct is blocked, the tears have nowhere to go: the eye tears, and mucus and tears stagnate in the bag.

In infants, obstruction is usually congenital: a thin membrane remains at the lower end of the duct. In adults, it is acquired - the mucous membrane of the duct becomes inflamed, swollen and gradually scarred; sometimes the duct is damaged by trauma to the face.

Congestion in the lacrimal sac can become infected - this is dacryocystitis. Acute looks like a painful red swelling near the inner corner of the eye, chronic looks like a long mucous or purulent discharge from the corner of the eye.

This is general information. What will suit you or your child, the doctor will tell after the examination.

02 / SIGNS

How
impassability presents.

The main symptom is tears that do not have time to flow down the nose. Inflammation adds discharge, pain and swelling.

Lacrimation

The eye tears even indoors, tears run down the cheek.

Allocation

Mucus or pus collects in the corner of the eye.

Irritated skin

The skin of the eyelids becomes wet and irritated from constant moisture; possible inflammations such as conjunctivitis.

Swelling near the corner of the eye

Painful red swelling near the nose is a sign of acute dacryocystitis. In a series of 347 eyes with acute dacryocystitis, 23% already had a lacrimal sac abscess at presentation.

03 / REASONS

Why the channel
gets clogged

Children and adults have different causes, which is why they are treated differently.

Congenital membrane

In babies, the duct is covered by a thin membrane at its lower end; such obstruction occurs in 5–20% of young children.

Inflammation of the duct

In adults, the mucous membrane becomes inflamed, swollen and scarred for no apparent reason. According to a systematic review, the reasons are multifactorial; hormonal factors explain them only partially.

Injury

In a series of 28 patients with post-traumatic obstruction, the most common cause was a motor vehicle accident (70%), and the most common injury was nasal, orbital, and ethmoid fractures (64%).

Fractures of the orbit

Not only the strait

The eye also tears when the lower eyelid is drooping or everted or when the eye is dry.

Ectropion

Rarely - a tumor

Tumors of the lacrimal tract are rare: in a series of 525 endoscopic operations, the tumor was found in four cases.

04 / SEEK MEDICAL ADVICE

When to seek medical advice?

Tearing itself does not require emergency care. But acute dacryocystitis can spread to tissues around the eye: in a series of 347 eyes with acute dacryocystitis, this happened in 2.8%. Then, as well as after surgery near the eye, some signs require immediate help.

103 immediately if:

suddenly stopped seeing in one or both eyes;
severe pain in the eye suddenly appeared;
swelling and redness from the corner of the eye spread to the eyelids;
the eyelids are so swollen that the eye does not open;
it hurts to move the eye;
the eye protrudes forward;
double vision appeared or vision worsened;
with inflammation near the eye - very high temperature, fever or chills;
very frequent heartbeat or breathing;
feel dizzy or feel like you're about to faint;
confusion or disorientation appeared;
skin is cold, clammy, pale, blue, or marbled;
the person or child has passed out, is difficult to wake up, or is unresponsive;
after surgery on the tear ducts, pain in or around the eye increases;
after the operation, the eye became tense or the eyelids do not open;
after surgery, bleeding from the nose lasts longer than 10-15 minutes, is very strong, or the blood has to be swallowed so that it is nauseating;
the child has difficulty breathing or breathes very often - croaks or pulls in the stomach during inhalation;
the child has swollen lips, tongue or throat, and it is difficult for him to swallow or make sounds;
the child has a rash that does not fade if you press on it;
temperature of 38 °C and above in a child under 3 months or 39 °C and above in a child of 3–6 months;
the child's temperature is below 36 °C, it is cold to the touch or shivering;
the child cries weakly, shrillly or continuously;
the child did not urinate for 12 hours;
convulsions began.

Do not delay a visit to the doctor:

On the same day: a painful, hot, red swelling appeared near the inner corner of the eye, but it did not spread to the eyelids, the eye does not protrude and sees as usual; a red eye in a baby who is not yet 28 days old; after the operation, the seam turned red, discharge appeared or the temperature rose - call the surgeon who operated. Planned: the eye constantly tears and it interferes; mucus or pus is released from the corner of the eye; there is a lump or swelling near the eye that does not go away. The baby's eye has been watering since the first weeks, but it is not red and not swollen - show it to the pediatrician or an ophthalmologist regularly: it often goes away on its own.

05 / DIAGNOSTICS

As defined,
where is the obstacle

Discussion and review
Since when the eye is watering, have there been inflammations, facial injuries, nose operations; examination of the eyelids and corner of the eye.
Washing
Through the lacrimal point, a liquid is injected and see if it gets into the nose - this is how patency is checked.
Examination of the nose
The nasal cavity is examined, if necessary, with an endoscope, especially before surgery through the nose.
CT scan if necessary
After a facial injury, CT with contrast in the lacrimal tract helps to assess the damage and plan surgery.
Other reasons
It is checked whether the inversion of the eyelids or dryness of the eye does not cause tearing.

06 / TREATMENT

How we treat
impassability

Babies usually start with observation and massage, because the obstruction often goes away on its own. In adults, persistent blockage is treated with surgery that creates a new path for the tears.

In babies

Often passes without surgery.

Follow-up: In the cohort of 1958 infants, obstruction passed by itself by 3 months in 47.3%, by 6 months — in 66.4%, by 12 months — in 78.4%.
Massage: The doctor shows the technique of massaging the lacrimal sac area. In the same cohort, 89.7% of children who were prescribed massage and 74.6% of those who were only observed survived without surgery; this is an observational study, so it shows association, not causation.
drops: The doctor prescribes antibiotic drops if there is an infection.
Probing: If it does not pass, the membrane in the duct is opened with a thin probe. A review by the American Academy of Ophthalmology considers it acceptable to delay it to 12–18 months; in the cohort of 1998 children, after 15 months, probing was less successful. No serious complications were reported in the studies; in one of them, the tear point bled after 20% of probings.

In adults

The operation creates a new path for tears to bypass the blockage.

Dacryocystorhinostomy: A new hole is made in the bone between the lacrimal sac and the nasal cavity. Access — through the nose under the control of an endoscope or through a skin incision on the side of the nose.
The result: In a review of 73 studies (4,800 patients), the success of surgery through an incision in various studies was at least 65%, endoscopic without laser — from 84 to 94%; complications during surgery — 1%, after it — 6%.
Through the nose or through the skin: A meta-analysis of 19 studies showed comparable results of endoscopic surgery with instruments and surgery through an incision, and laser surgery gave worse results; endoscopic does not leave a scar on the skin. A Cochrane review of two small studies found the comparison uncertain.
Silicone tube: It is sometimes installed during surgery; according to a review of 73 studies, there is little evidence that it increases success.

Acute dacryocystitis

Antibiotics and drainage: Inflammation is treated with antibiotics; the abscess is opened if necessary. In a series of 320 patients, acute manifestations passed in an average of 10 days.
When to operate: Usually dacryocystorhinostomy is performed after the inflammation subsides. In a meta-analysis of 6 studies (288 patients), early surgery through the nose provided similar success and reduced swelling more quickly.
Fistula: In 5.6% of 320 patients, a course on the skin (fistula) was formed - mostly after the abscess broke through on its own.

07 / AT THE VALIKHNOVSKYI INSTITUTE

How
we treat it.

Obstruction of the lacrimal ducts at Dr. Valikhnovskyi's Institute of Surgery refers to the "New Face" direction - when it is associated with facial trauma, orbital and nasal fractures, or the position of the eyelids. The clinic is responsible for its part: bones, eyelids and tissues around the eye. Children with congenital obstruction, as well as treatment of the tear ducts themselves, including sounding and dacryocystorhinostomy, are managed by an ophthalmologist.

CLINIC SERVICE A new face Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes. View service

What we do for this condition

CT of the facial skull — basic examination for facial injuries; in case of orbital injuries, an ophthalmologist's examination is mandatory.
Treatment of fractures of the orbit and nose - the fragments are aligned and fixed with titanium plates, and the bones that have joined with displacement are dissected and rearranged (osteotomy).
Lateral tarsal stripe — if tears flow due to sagging or inversion of the lower eyelid, it is pulled up and fixed near the outer corner of the eye.
Canthopexy and canthoplasty — restoring the position of the outer corner of the eye when the eyelid moves away from the eye.

Rostislav Valikhnovskyi

Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.

About the doctor ORCID

How treatment works with us

Photo onlineSend photos of the eyes and, if available, CT scans and discharges - the doctor will pre-evaluate the situation.
ConsultationExamination of the eyelids and corner of the eye; if necessary — CT. We find out whether the cause is in the duct, in the eyelids or in the consequences of the injury.
PlanWhat is done in the clinic, and what is done at the ophthalmologist; in which sequence.
SurgeryOn the bones of the face or on the eyelids - as indicated.
RecoveryThe first days — swelling; follow-up examinations until everything is healed.

Discuss your case Call

08 / QUESTIONS AND ANSWERS

Common
questions

Short answers. What is right for you, the doctor will tell you during the consultation.

Will the obstruction pass in the baby by itself?

Often yes. In the cohort of 1958 infants, it passed by itself by 6 months in 66.4% of children, and by 1 year in 78.4%. If redness and swelling appear near the inner corner of the eye, go to the doctor on the same day, and for alarming signs from the section "When to contact" - 103.

Does massage help?

In a large cohort, obstruction without surgery resolved more often in children who were prescribed massage than in those who were only observed. The doctor will show you the massage technique.

When is the child probed?

If the obstruction persists. A review by the American Academy of Ophthalmology suggests that waiting up to 12 to 18 months is acceptable because many children recover sooner without intervention.

Can an adult do without surgery?

Antibiotic drops are prescribed by a doctor for infection. Persistent blockage of the duct in adults is treated with dacryocystorhinostomy — the authors of a review of 73 studies call it an effective and safe method.

Is the operation performed through the nose or through an incision?

Both ways are possible. In reviews, the results of endoscopic surgery with instruments and surgery through an incision are compared; endoscopic does not leave a scar on the skin. The method is chosen by the surgeon.

Is dacryocystitis dangerous?

Usually, the inflammation is limited to the area near the corner of the eye, but it can spread to the tissues around the eye. In a series of 13 such patients, all required immediate opening of the abscess and intravenous antibiotics; vision remained stable or improved in all after treatment. Signs of spread are a reason to call 103.

Why does the eye water if the duct is open?

There are other reasons for tearing: inversion or sagging of the lower eyelid, dry eye, allergy or infection. Therefore, before treatment, the doctor examines both the eyelids and the eye itself.

09 / SOURCES

Sources

21 sources · reviews, guidelines and researchshowCollapse

Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstructionCochrane Database of Systematic Reviews, 2017doi:10.1002/14651858.CD007097.pub3 ↗
Systematic review and meta-analysis on outcomes for endoscopic versus external dacryocystorhinostomyOrbit, 2014doi:10.3109/01676830.2013.842253 ↗
A systematic review of outcomes after dacryocystorhinostomy in adultsAmerican Journal of Rhinology & Allergy, 2010doi:10.2500/ajra.2010.24.3393 ↗
Probing for congenital nasolacrimal duct obstructionCochrane Database of Systematic Reviews, 2017doi:10.1002/14651858.CD011109.pub2 ↗
Office- or Facility-Based Probing for Congenital Nasolacrimal Duct Obstruction: A Report by the American Academy of OphthalmologyOphthalmology, 2021doi:10.1016/j.ophtha.2020.10.028 ↗
Spontaneous Resolution and Timing of Intervention in Congenital Nasolacrimal Duct ObstructionJAMA Ophthalmology, 2018doi:10.1001/jamaophthalmol.2018.3841 ↗
Spontaneous resolution rates in congenital nasolacrimal duct obstruction managed with massage or topical antibiotics compared with observation aloneBritish Journal of Ophthalmology, 2022doi:10.1136/bjophthalmol-2021-318853 ↗
The incidence of pediatric dacryocystitis among a population-based cohort of infants with congenital nasolacrimal duct obstructionJournal of AAPOS, 2024doi:10.1016/j.jaapos.2024.103928 ↗
Presentation, Diagnostic Evaluation, Management, and Rates of Serious Bacterial Infection in Infants With Acute Dacryocystitis Presenting to the Emergency DepartmentPediatric Infectious Disease Journal, 2020doi:10.1097/INF.0000000000002848 ↗
Etiopathogenesis of Primary Acquired Nasolacrimal Duct Obstruction: What We Know and What We Need to KnowOphthalmic Plastic and Reconstructive Surgery, 2019doi:10.1097/IOP.0000000000001310 ↗
Clinical profile and management outcome of acute dacryocystitis: two decades of experience in a tertiary eye care centerSeminars in Ophthalmology, 2015doi:10.3109/08820538.2013.833269 ↗
Clinical and microbiologic features of dacryocystitis-related orbital cellulitisOrbit, 2016doi:10.1080/01676830.2016.1176214 ↗
Early Endonasal Dacryocystorhinostomy for Acute Dacryocystitis: A Systematic Review and Meta-AnalysisAmerican Journal of Rhinology & Allergy, 2024doi:10.1177/19458924241237009 ↗
Nasolacrimal duct tumours in the era of endoscopic dacryocystorhinostomy: literature reviewThe Journal of Laryngology & Otology, 2013doi:10.1017/S0022215113001163 ↗
Traumatic nasolacrimal duct obstruction: clinical profile, management, and outcomeEuropean Journal of Ophthalmology, 2013doi:10.5301/ejo.5000256 ↗
Watering eyesNHS, 2024nhs.uk/symptoms/watering-eyes ↗
Vision lossNHS, 2025nhs.uk/conditions/vision-loss ↗
Red eyeNHS, 2025nhs.uk/symptoms/red-eye ↗
CellulitisNHS, 2024nhs.uk/conditions/cellulitis ↗
NosebleedNHS, 2023nhs.uk/conditions/nosebleed ↗
When to get urgent medical help for babies and children under 5NHS, 2026nhs.uk/baby/health/when-to-get-urgent-medical-help-for-babies-and-children-under-5 ↗

The figures on the page are from these sources.

VALIKHNOVSKI SURGERY PARTNERS

Eye constantly
tears?

Send a photo of the eyes and describe how long it has been going on. The doctor will tell you where the cause is and who to contact.

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