A blocked tear duct in adults is most often caused by age-related narrowing of the drainage passage, long-term inflammation or repeated infections, facial injury, previous eye or nasal surgery, chronic sinus disease, growths near the drainage system, or certain medications. Anything that scars, swells, compresses, or narrows the small channels carrying tears from the eye into the nose can stop tears from draining properly. The result is usually the same frustrating symptom: watery eyes that never seem to dry up.
At The Oculofacial Center in Bethesda, MD, Dr. Viraj Mehta specializes in diagnosing the precise origin of this condition and treating it with targeted approaches including lacrimal surgery, tear duct reconstruction, and stent placement.
To understand what goes wrong, it helps to know how the tear drainage system – the lacrimal system – normally works.
Your eyes make tears constantly, not just when you cry. Tears are produced by the lacrimal gland above the outer part of each eye, and a thin film keeps the eye’s surface smooth, comfortable, and clear of debris. Every blink pushes that fluid toward the inner corner of your eye.
There, two tiny openings called puncta (one in the upper eyelid, one in the lower) act like small drains. Tears pass through these openings into short channels called canaliculi, then into the lacrimal sac on the side of the nose, and finally down the nasolacrimal duct into the nasal cavity. That is why your nose runs when you cry.
When any part of that pathway becomes narrowed, scarred, swollen, or blocked, tears have nowhere to go. A partial blockage causes intermittent watering; a complete blockage causes constant tearing that spills onto the cheek. Doctors call this epiphora.
A thorough evaluation by an oculofacial specialist like Dr. Viraj Mehta is critical for an accurate diagnosis. Here is a closer look at the causes, from the most frequent to the least.
Age is the single most common factor. Over decades, the nasolacrimal duct gradually narrows: the tissue lining thickens, the surrounding bony canal tightens, and the soft tissues lose tone. This slow narrowing is called primary acquired nasolacrimal duct obstruction, and it occurs most often in adults over 40 – more frequently in women, partly because the bony tear duct canal tends to be narrower.
The puncta themselves can also narrow, a condition called punctal stenosis, making it difficult for tears to enter the system at all. Many patients first notice symptoms during a cold or allergy season, when inflammation temporarily closes an already narrowed passage.
Aging affects the eyelids too. As the lower eyelid loses tension, it may sag away from the eye (ectropion) or roll inward (entropion), leaving the drainage openings out of position to collect tears. In those cases, the solution may involve eyelid malposition correction rather than duct surgery. Weak blinking, from aging or nerve problems, also reduces the pumping action that moves tears down the drain.
Repeated or long-standing inflammation is a major cause of scarring inside the tear drainage system. Each episode leaves behind a small amount of scar tissue, and over years that scarring can close the passage entirely. Common triggers include:
Chronic conjunctivitis. Ongoing irritation from allergies, bacteria, or viruses can spread to the drainage openings and cause them to swell and scar.
Dacryocystitis. Infection of the lacrimal sac produces a painful, red, swollen bump between the eye and nose, sometimes with pus. Blockage and infection feed each other, and a severe infection can leave permanent scarring even after it resolves.
Canaliculitis. Infection of the small canals just inside the eyelid causes chronic discharge and eventual narrowing.
Chronic blepharitis. Long-term eyelid margin inflammation keeps the area irritated and can affect the punctal openings.
Inflammatory and autoimmune conditions. Sarcoidosis, granulomatosis with polyangiitis (formerly Wegener’s granulomatosis), lupus, and certain viral infections can all involve the lacrimal system.
The tear drainage system runs through delicate, thin bone where the nose meets the eye socket – an area that takes the brunt of many facial injuries.
Nasal or facial fractures. A broken nose or mid-face fracture can sever, crush, or displace the lacrimal sac or bony duct canal, and healing bone can entrap the duct.
Eyelid lacerations. A cut through the inner corner can sever the canaliculi, which heal closed if not repaired promptly and precisely.
Direct blows. Sports injuries, falls, car accidents, and dog bites frequently damage this region – even without a fracture, swelling and soft tissue damage can scar as it heals.
Foreign debris. Dirt or debris entering the punctum after an injury can lodge in the system and physically obstruct it.
Chemical or thermal burns. Burns to the eyelid area cause scarring that can seal the drainage openings.
Radiation scarring. Radiation treatment to the head and neck can scar down the duct lining over time.
Tearing does not always begin right away – some patients notice a watery eye months or years later as scar tissue matures and contracts. Trauma to this region is a core focus at The Oculofacial Center.
Surgery in or near the drainage pathway can inadvertently disrupt it. This does not mean these procedures should be avoided – only that persistent tearing afterward is worth evaluating.
Sinus surgery. Endoscopic sinus procedures work very close to the nasolacrimal duct where it opens into the nose.
Nasal surgery. Septoplasty, turbinate reduction, or rhinoplasty can alter the anatomy around the duct’s opening.
Skin cancer removal. Removing a lesion near the inner eyelid corner, followed by reconstruction, may scar the drainage channels.
Facial reconstruction. This procedure can alter the anatomy around the tear ducts.
Radiation therapy. Treatment for head or neck tumors can cause extensive scarring of nasal and ocular tissues.
The tear duct empties into the nose, so nasal conditions can block it from below. Many patients with this pattern notice tearing worsens during allergy season or with a cold.
Chronic sinusitis. Ongoing swelling of the nasal lining can close off the duct’s opening.
Nasal polyps. These noncancerous growths can physically block the drainage outlet.
Deviated septum. A significantly crooked septum can crowd the space where the duct opens and press on the nasal side wall.
Severe allergic rhinitis. Persistent congestion and swelling narrow the outflow.
Enlarged turbinates. The structures that warm and humidify air can swell enough to obstruct the duct’s exit.
Growths are a less common but important cause. A mass anywhere along the pathway – eyelid, lacrimal sac, nose, or sinus – can compress or invade the duct. Most are benign, such as papillomas or cysts, but some are malignant. Dacryoliths, small stones formed from cellular debris and mucus in the lacrimal sac, can also cause tearing that comes and goes.
Warning signs suggesting a growth rather than simple narrowing:
Bloody tears or blood-tinged discharge
A firm mass above the level of the inner corner tendon
One-sided tearing in a younger adult with no clear cause
Swelling that does not respond to antibiotics
Numbness or vision changes accompanying the tearing
Any of these deserves prompt evaluation. Dr. Viraj Mehta has the expertise to assess the entire lacrimal system and surrounding structures, using CT or MRI imaging when a mass is suspected.
Several medications are known to narrow or close the tear drainage system.
Chemotherapy agents. Docetaxel (Taxotere) and 5-fluorouracil are well-documented causes of tear duct inflammation and scarring.
Radioactive iodine. Used for thyroid conditions, it concentrates in the lacrimal sac and can cause narrowing months later.
Glaucoma eye drops. Long-term use, particularly of preserved drops, can inflame and scar the puncta and canaliculi.
Antiviral eye drops. Extended courses have been associated with punctal and canalicular closure.
Nasal decongestant sprays. Overuse can cause rebound nasal swelling that affects drainage.
If you develop a watery eye after starting one of these, mention it to your prescribing doctor and an eye specialist. Early recognition sometimes allows for protective measures – or a switch in medication – before permanent scarring develops.
Thyroid eye disease. Swelling around the eye can affect eyelid position and tear drainage; thyroid eye disease management is another focus at the practice.
Facial nerve weakness. Conditions like Bell’s palsy weaken the blink and reduce the tear pump.
Chronic dry eye. Dry eye triggers reflex tearing, overwhelming a duct that is already partly narrowed.
Contact lens wear. Long-term wear can contribute to chronic surface irritation.
Smoking and environmental irritants. These promote chronic nasal and ocular inflammation.
Unmanaged allergies. Years of persistent inflammation take a toll on the drainage lining.
Not every watery eye means a blocked duct. Eyelid position problems, eyelash misdirection, dry eye, corneal irritation, and ptosis can all produce tearing – which is why a careful, structured examination determines the right treatment.
Occasional watering from wind, onions, or a stray eyelash is normal. Persistent tearing is not.
Schedule an evaluation if you notice:
Tearing that lasts more than a few weeks or interferes with vision and daily activities
Tears running down your cheek during ordinary activities
Blurred vision from a constant film of tears
Repeated eye infections, conjunctivitis, or inflammation
Thick, mucus-like discharge or crusting in the corner of your eye
Skin irritation or breakdown from constant wiping
Seek care promptly if you develop:
A painful, red, swollen lump between your eye and nose
Fever along with eye-area swelling
Pus draining from the inner corner
Blood-tinged tears
Sudden vision changes or double vision
Numbness in the cheek or around the eye
Evaluation at The Oculofacial Center typically includes a review of your symptoms and medical history, examination of eyelid position and blink quality, inspection of the punctal openings, and gentle probing and irrigation of the drainage system to pinpoint where the blockage sits. Nasal endoscopy or imaging may be added when a nasal cause or a growth is suspected.
Treatment depends entirely on the location and cause of the obstruction. Options at our practice include:
Tear duct reconstruction to restore damaged channels
Stent placement for partial or reopened blockages
Lacrimal surgery (DCR) to create a new drainage pathway when the duct is completely closed
Persistent watery eyes are a symptom worth investigating, not something to live with indefinitely. Because so many conditions produce the same tearing, an accurate diagnosis – pinpointing exactly where along the drainage pathway the problem sits – determines whether the answer is eyelid correction, stent placement, reconstruction, or DCR surgery.
If tearing, crusting, or recurring infections have become part of your daily routine, board-certified oculofacial surgeon Dr. Viraj Mehta can identify the root cause and outline your options.
About the Author
Viraj J. Mehta, MD, MBA
