Tearing & Lacrimal (DCR Surgery)
Understanding Excessive Tearing and Lacrimal Obstruction
Your eyes make tears all day long to keep your eyes moist and healthy. When your tear drainage system is working properly, you do not notice these tears. But when the tiny tubes that drain tears into your nose become blocked, tears have nowhere to go and spill onto your cheeks instead.
This overflow of tears is called epiphora. It can be annoying and embarrassing, and it may make it hard to see clearly throughout the day.
While blocked tear drainage is one cause of watery eyes, many other problems can make your eyes tear excessively. Our eye doctor will evaluate whether your tearing is from poor drainage or from too much tear production, because treatment depends on the underlying cause.
- Dry eye syndrome that triggers reflex tearing to compensate
- Blepharitis or meibomian gland dysfunction causing irritation
- Allergies or chronic conjunctivitis
- Eyelid laxity, ectropion, or entropion that disrupts the tear pump
- Irritation from a foreign body or corneal abrasion
- Medication side effects affecting the eye surface
Tears drain through two tiny openings called puncta at the inner corner of your upper and lower eyelids. From there, they flow through small tubes called canaliculi into a sac called the lacrimal sac. The lacrimal sac sits just below the skin between your eye and your nose.
From the lacrimal sac, tears travel down a tube called the nasolacrimal duct and empty into your nose. This is why your nose runs when you cry. When any part of this system becomes blocked, tears back up and overflow.
In adults, lacrimal obstruction often develops slowly over many years. The most common cause is age-related narrowing of the nasolacrimal duct. As we get older, the delicate tissues can swell and close off the drainage pathway.
- Chronic inflammation or infection in the nose or sinuses
- Previous injury or trauma to the face or eye area
- Nasal polyps or tumors that press on the drainage system
- Previous surgery or radiation therapy near the eyes or nose
- Certain medications or eye drops used over long periods
Women develop blocked tear ducts more often than men, and the risk increases with age, particularly in later adulthood. The drainage tube is narrower in women, making it easier for inflammation to cause a blockage. People who have chronic sinus infections or nasal allergies also face higher risk.
If you have had an eye or facial injury in the past, your drainage system may have scar tissue that leads to problems later in life. People who have had radiation therapy to the face may develop narrowing of the tear ducts months or years after treatment.
Recognizing Symptoms and Warning Signs
The hallmark of lacrimal obstruction is persistent tearing that you cannot control. You may notice tears streaming down your face when you go outside in cold or windy weather. Bright lights and reading can also trigger more tearing.
Your vision may become blurry because of the pooling tears. You might find yourself constantly wiping your eyes or dabbing your cheeks with a tissue. The tearing usually affects just one eye, though both eyes can be involved.
When tears sit in the blocked lacrimal sac, they can become a breeding ground for bacteria. You may wake up with thick yellow or white mucus stuck to your eyelashes. Your eyelids might feel glued together in the morning.
- Sticky discharge that collects at the inner corner of your eye
- Crusty eyelids or eyelashes, especially after sleep
- A feeling of pressure or fullness near the inside corner of your eye
- Mild irritation or discomfort around the tear sac area
A blocked tear duct can lead to an infection of the lacrimal sac called dacryocystitis. When this happens, the area between your eye and nose becomes red, swollen, warm, and very tender. You may notice a painful lump near the inside corner of your eye. Acute dacryocystitis requires prompt same-day medical evaluation. Do not squeeze or attempt to drain the swelling at home, as this can worsen the infection or cause it to spread.
The infection can cause fever and make you feel sick overall. If the infection is not treated, it can spread to nearby tissues or even into the eye socket.
Most cases of excessive tearing are not urgent, but certain symptoms need immediate attention. Seek emergency care right away if you develop severe pain, rapid swelling, or redness spreading across your face. If you have a high fever along with eye swelling, do not wait to be seen.
Changes in your vision, double vision, or trouble moving your eye in all directions also signal a serious problem. These symptoms might mean that an infection has spread beyond the tear drainage system.
How We Diagnose Lacrimal Obstruction
We start by asking about your symptoms and medical history. We examine your eyelids, the surface of your eye, and the openings where tears drain. We gently press on the area over your lacrimal sac to check for swelling, tenderness, or discharge.
We also look inside your nose with a small light or instrument to see if there is swelling, polyps, or other problems that could block the drainage tube. A thorough examination helps us understand where the blockage is located.
Tearing can result from problems at different points in the drainage system or from issues outside the drainage system entirely. Our evaluation identifies whether the obstruction is in the puncta, the canaliculi, the lacrimal sac, the nasolacrimal duct, or whether the tearing is functional rather than structural.
Treatment depends on pinpointing the exact level and cause of the problem, because procedures designed for nasolacrimal duct obstruction may not help if the issue is higher up in the system or unrelated to drainage.
For this simple test, we place a drop of special orange dye called fluorescein on the surface of each eye. After a few minutes, we check to see how much dye remains. If your drainage system is open, most of the dye should disappear.
- We look at your eyes under a blue light to see the dye clearly
- If dye pools on the eye surface after five minutes, drainage may be poor
- Comparing both eyes helps us spot which side has a problem
- This test is painless and takes only a few minutes
If we suspect a blockage, we may irrigate your tear drainage system. We place numbing drops in your eye, then gently insert a tiny tube called a cannula into the drainage opening. We flush sterile saline through the system while you lean forward over a basin.
If the saline flows easily into your nose and you can taste it, your drainage system is open. If the fluid comes back out through the same opening or through the other drainage point, we know there is a blockage. This test helps us pinpoint exactly where the obstruction is located.
In some cases, we may recommend imaging to see the tear drainage system in detail. Imaging is selective and may include a CT scan to show bone, soft tissue, and the nasolacrimal duct anatomy, particularly when trauma, tumors, or unusual anatomy are a concern. Specialized contrast studies or endoscopic nasal evaluation may also be used depending on the clinical situation.
We order imaging when we need to plan for surgery, when we suspect a tumor or unusual anatomy, or when previous treatments have not worked. These studies give us a roadmap before we perform any procedure.
Non-Surgical Treatment Options
If your tearing is mild and does not bother you much, we may suggest simply monitoring the condition. Some partial blockages do not get worse over time. If you can manage the tearing with occasional tissue use and it does not interfere with your daily life, you may choose to wait.
We will ask you to return for follow-up visits so we can watch for any worsening or signs of infection. Many people live comfortably with minor tearing and never need further treatment.
Applying a warm, moist cloth to the inner corner of your eye can soothe irritation and help the drainage system work better. The gentle heat may reduce inflammation and encourage fluid to move through the ducts. Massage techniques are most helpful for congenital obstruction in infants and may offer limited benefit in adult nasolacrimal duct obstruction, though they can still soothe irritation or help when blepharitis or mucus contributes to symptoms. We often recommend this simple home care several times a day.
- Soak a clean washcloth in warm water and wring it out
- Place it over your closed eye for five to ten minutes
- Gently massage the area over the tear sac with your fingertip
- Press downward toward your nose while massaging to encourage drainage
- Repeat this routine two to four times daily
If you develop an infection of the lacrimal sac, we will prescribe antibiotic eye drops or pills. Oral antibiotics are usually necessary for dacryocystitis because the infection is deep in the tissues. You may need to take antibiotics for one to two weeks. Severe cases may require intravenous antibiotics and possibly drainage of the infected sac.
Treating the infection can reduce swelling and temporarily improve drainage. However, antibiotics do not fix a structural blockage, so symptoms often return once the medication is finished. Definitive tear drainage surgery is often planned once the infection is controlled, though in selected cases urgent endoscopic procedures may be considered depending on the situation.
For partial blockages, we may try dilating the drainage openings or gently probing the tear ducts. After numbing your eye, we may pass a very thin wire probe through the drainage system. In adults, probing is more often diagnostic or part of a procedure plan for selected partial stenosis rather than a definitive treatment. Balloon dilation or silicone intubation may be considered in some cases.
Office probing has limited long-term success in adults because the blockage is often lower down in the nasolacrimal duct. We may recommend it as a first step before considering surgery, especially if you prefer to avoid an operation.
DCR Surgery: The Definitive Treatment
Dacryocystorhinostomy, or DCR, is a surgical procedure that creates a new pathway for tears to drain into your nose. The operation bypasses the blocked nasolacrimal duct by making a direct opening between the lacrimal sac and the inside of your nose. This allows tears to flow freely again.
DCR is a widely used definitive treatment for complete nasolacrimal duct obstruction with high success rates. It has been performed for over a century and continues to be an established procedure in 2025.
We may recommend DCR if you have persistent tearing that affects your quality of life and simpler treatments have not helped. DCR is mainly indicated for nasolacrimal duct obstruction and selected cases of functional obstruction. Candidates for surgery include people with complete blockage of the nasolacrimal duct confirmed by testing. If you have had multiple infections of the lacrimal sac, surgery can prevent future episodes.
- Constant tearing that interferes with reading, driving, or daily tasks
- Recurrent or chronic infections despite antibiotic treatment
- Significant discomfort or skin irritation from moisture on the cheeks
- Confirmed blockage that has not improved with conservative care
There are two main approaches to DCR surgery. External DCR involves a small skin incision on the side of your nose near the inner corner of your eye. The surgeon creates a new opening through the bone and connects the lacrimal sac to the nose. This traditional method gives excellent visibility and high success rates.
Endoscopic DCR is performed entirely through the nostril using a tiny camera and instruments. There is no skin incision, so there is no external scar. Both techniques work well, and we will discuss which approach is best for your anatomy and situation.
DCR is usually done under general anesthesia or deep sedation with local anesthesia. The surgery takes about one to two hours. During the procedure, we create a small opening in the bone between the lacrimal sac and the nasal cavity. We then make an opening in the sac itself and connect the edges of the sac to the lining of your nose.
We often place a tiny silicone tube through the drainage system to keep the new pathway open while it heals. This tube runs from the corner of your eye down into your nose and stays in place for several weeks to months. Some patients notice mild irritation or awareness of the tube, though many do not feel it during normal activities.
Most people go home the same day as surgery. You may have bruising and swelling around your eye and nose that peaks at two to three days and improves over the next week or two. Mild discomfort is normal, and we will prescribe pain medication if needed.
- Plan for one to two weeks of social downtime due to bruising
- Avoid heavy lifting, bending, and straining for two weeks
- Keep your head elevated when resting to reduce swelling
- You may have bloody nasal drainage or light nosebleeds for a few days
- We typically remove the silicone tube in the office after two to three months
- Before surgery, we will review all your medications and give you individualized instructions about blood thinners, anti-inflammatory drugs, and supplements
Following your surgery, we will give you detailed instructions for care at home. You will need to use antibiotic and anti-inflammatory eye drops or nasal sprays for several weeks. Gently rinsing your nose with saline spray can help keep the surgical area clean and moist.
Do not blow your nose forcefully for at least two weeks, as this can disrupt healing or cause bleeding. Sneeze with your mouth open to avoid pressure buildup. Call our office urgently if you experience heavy or persistent nosebleed, worsening swelling or redness, fever, increasing pain, decreased vision, double vision, or severe headache. We will see you for follow-up visits to monitor healing and check that the new drainage pathway is working properly.
DCR Surgery Risks, Complications, and Alternatives
As with any surgery, DCR carries risks. Most people have successful outcomes, but it is important to understand possible complications so you can make an informed decision and recognize warning signs after surgery.
- Bleeding during or after surgery, including nosebleeds
- Infection at the surgical site or in the surrounding tissues
- Visible scarring on the side of the nose with external DCR
- Failure of the new drainage pathway or narrowing over time
- Persistent tearing if the underlying cause was not drainage obstruction
- Irritation, displacement, or infection related to the silicone stent
- Nasal adhesions, granulation tissue, or chronic sinus symptoms
- Anesthesia-related risks
- Very rare serious complications such as cerebrospinal fluid leak, orbital injury, or vision loss
DCR is not the right choice for every case of tearing. Depending on the cause and location of your problem, other treatments may be more suitable or may be tried first.
- Punctoplasty or punctal dilation for punctal stenosis
- Eyelid tightening or malposition repair for ectropion, entropion, or eyelid laxity
- Balloon dacryoplasty with or without silicone intubation for selected cases
- Treatment of ocular surface disease, dry eye, allergies, or blepharitis
- Observation for mild symptoms that do not affect quality of life
- Endoscopic versus external DCR approach tailored to your anatomy
- Conjunctivodacryocystorhinostomy or Jones tube placement for canalicular obstruction
Frequently Asked Questions
If you have external DCR, you will have a small scar on the side of your nose between your eye and the bridge. The incision is usually less than half an inch long and placed in a natural fold or crease.
Most scars fade significantly over several months and become hard to notice. Endoscopic DCR leaves no visible scar because all work is done inside the nose.
DCR has a success rate of about 85 to 95 percent for relieving tearing when performed by an experienced surgeon. Most people notice a dramatic improvement in symptoms and no longer have tears running down their face.
Success rates are similar for both external and endoscopic approaches when done by experienced surgeons. Individual results depend on your specific anatomy and the underlying cause of the obstruction.
It is possible for the new opening to narrow or close over time, though this is uncommon. Scarring or inflammation can sometimes cause the pathway to become blocked again, usually within the first few months.
If symptoms return, we may need to perform a minor procedure to reopen the passage or replace the silicone tube temporarily. Most patients maintain good drainage long-term after successful DCR.
You should avoid strenuous exercise, heavy lifting, and activities that raise your blood pressure for at least two weeks after surgery. Light walking is fine and actually helps with healing.
Most people can return to desk work within a few days, but you should wait until bruising has improved before resuming public-facing activities. Always check with our eye doctor before going back to contact sports or swimming.
The amount of time depends on your job and the type of DCR you have. Many people take about one week off work, though some return sooner if their job does not involve physical labor.
If your work is very visible to the public, you may want to plan for up to two weeks to allow bruising to fade. Discuss your specific work demands with us so we can help you plan appropriately.
Getting Help for Tearing & Lacrimal (DCR Surgery)
If you have constant tearing that disrupts your life, or if you notice swelling or discharge near the inner corner of your eye, schedule an appointment with our eye doctor for a complete evaluation. We will perform the necessary tests to diagnose the cause of your symptoms and discuss all treatment options with you. With the right care, most people find lasting relief from blocked tear ducts.