Nasolacrimal drainage dysfunction

Nasolacrimal drainage dysfunction is a blockage or stenosis of the tube that collects tears from the inner corner of the eye and drains them into the nose. It causes epiphora, irritation and blurred vision. The condition can be congenital, but when it is acquired, it can be caused by infections, inflammation, medications or surgery. However, most cases are idiopathic and occur as a result of aging but are more common in females. This Clinical Management Guideline outlines the aetiology, signs and symptoms and evidence-based recommendations for diagnosing and treating nasolacrimal duct obstruction. It provides recommendations for non-pharmacological management and treatment, and outlines when referral for possible surgery is appropriate.

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What is nasolacrimal drainage dysfunction?

The narrow tube that collects tears from the inner corner of each eye and drains them to the inside of the nose is called the nasolacrimal duct. Normally it functions well but it may sometimes become blocked, which can make the eyes watery. This may happen as the result of infection, inflammation or the effects of medications or surgery.  Occasionally babies are born with the duct(s) not fully open, but most open naturally without treatment before the age of 12 months.

How is nasolacrimal drainage dysfunction managed?

In adults, the blockage can be confirmed by attempting to pass a little saline solution through the nasolacrimal duct, using a small syringe. Fluorescein dye can also be used to test whether the duct is free. Syringing by itself may sometimes clear the blockage. If infection is the cause, antibiotic drops may be needed.

If the optometrist’s management of the condition is not successful, the patient should be referred to the ophthalmologist (specialist eye doctor), who may carry out further tests including special X-rays. If surgery is needed, a new drainage passage for the tears can be created between the tear sac (at the inner corner of the eye) and the inside of the nose; this can be done either using conventional surgical instruments or with the aid of a laser.

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Last updated

Nasolacrimal drainage dysfunction - 5 August 2026
The aetiology section has been revised to provide a more accurate description of the potential sites of obstruction/stenosis within the lacrimal drainage system and the causes of nasolacrimal drainage dysfunction (NDD). The title of the CMG has therefore been changed from 'Nasolacrimal duct obstruction' to 'Nasolacrimal drainage dysfunction' to reflect these changes and align with terminology used in the scientific literature. The predisposing factors section has been updated to provide clarity on which factors contribute toward congenital and acquired forms of NDD. The signs section has been revised to include descriptions of recommended diagnostic procedures to investigate congenital and acquired cases of NDD, which were previously included in the non-pharmacological management section. The management category section has been updated to include an additional referral recommendation where congenital dacryocystocele is suspected, and revised guidance on the timing of referral for probing in congenital cases of NDD.

Version 10
Date of search 15.04.26
Date of revision 30.04.26
Date of publication 05.08.26
Date for review 14.08.28
© The College of Optometrists