Blocked tear duct / epiphora (watery eyes)

Disclaimer

These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Referral to Emergency Department:
If any of the following are present or suspected, please refer the patient to the Emergency Department (via ambulance if necessary) or seek emergency medical advice if in a remote region.
Neonates with:

Visible swelling over the lacrimal sac, bluish discolouration of overlying skin, or a pus-filled abscess
Cellulitis and not responding to treatment with antibiotics or with signs of sepsis

Immediately contact on-call registrar or service to arrange an immediate Ophthalmology (Paediatric) assessment (seen within 7 days):

Epiphora (watery eyes) with complications (i.e. enlarged eye(s) (horizontal corneal diameter >12.0mm), photophobia, or a cloudy cornea)
Epiphora (watery eyes) with associated mass around the eye or in the lacrimal sac, or cellulitis
Dacryocystitis

Introduction

If the tear duct is blocked the tears will not drain properly and will spill over onto the cheek. The mucus produced by the tear sac also will not drain. The result is a watery and sticky eye.

Pre-referral investigations

Nil.

Pre-referral management

Reassure the family that in most cases the duct will open spontaneously, and the discharge is usually mucus from the duct and not necessarily a sign of conjunctivitis.
Educate the family on how to massage the nasolacrimal sac, keeping the eye clean and signs of infection. Provide Blocked tear duct - PCH Health Fact sheet.
Treat infection as required.
A red painful lump at the side of the nose may indicate dacryocystitis and will require oral antibiotics and urgent referral to PCH Ophthalmology Department.

When to refer

Refer to the Ophthalmology Department when:

Epiphora (watery eyes)/blocked tear duct:
- Not responsive to standard medical treatment
  or
- Still present after the age of 12 months.

How to refer

Routine non-urgent referrals from a GP or a Consultant should go to the Central Referral Service
Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals go to the PCH Referral Office
Urgent referrals (less than seven days) go to the PCH Referral Office. Please call Perth Children’s Hospital Switch on 6456 2222 to discuss referral with the relevant speciality.

Essential information to include in your referral

History

Relevant history, onset, duration, and severity of symptoms
Details of previous treatment and outcome
Current medication list
Any known allergies

Examination

For children aged ≥ 5 years: best corrected visual acuity

Useful resources

Royal Children’s Hospital Melbourne Clinical Practice Guideline: Eye Examination
Royal Children’s Hospital Melbourne Pre-Referral Guideline: Sticky &/or Watery Eye

Reviewer/Team:	Ophthalmology Department, PCH	Last reviewed:	May 2026
Endorsed by:	Ophthalmology Department, PCH	Date:	May 2026

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