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The lacrimal punctum is a tiny opening on the inner edge of the upper and lower eyelids that serves as the entry point for tear drainage. Each eye has two puncta, and they sit on small elevations called lacrimal papillae. Tears collect near the inner corner of the eye and enter the puncta before moving into the canaliculi. If a punctum is blocked or narrowed, tears may overflow onto the cheek.
read more about lacrimal punctum ...The puncta are found near the nose on the upper and lower lid margins, angled toward the tear meniscus. They appear as small dark dots and are easiest to see when the lower lid is gently turned outward. The upper punctum drains into the upper canaliculus, and the lower punctum drains into the lower canaliculus. Both channels usually join before entering the lacrimal sac.
After tears enter a punctum, they travel through the canaliculus and into the lacrimal sac, then down the nasolacrimal duct into the nasal cavity. Blinking helps act as a pump that moves tears through this pathway. Valves and the direction of flow help limit backflow toward the eye. This is why your nose can run when you cry.
Punctal issues often cause epiphora, which means excessive tearing.
Evaluation may include slit-lamp exam, gentle irrigation, and tests that check tear drainage. Treatment depends on the cause and may include lubricants, treating eyelid inflammation, punctal dilation, or a minor procedure such as punctoplasty to enlarge a narrowed opening. Temporary punctal plugs can also be placed intentionally to reduce tear drainage in some dry eye cases. If infection is suspected, prompt medical treatment is important to protect the drainage system.
Each eye typically has two puncta, one on the upper eyelid and one on the lower eyelid near the inner corner. Both can contribute to draining tears into the canaliculi and lacrimal sac.
If a punctum is narrowed or blocked, tears cannot enter the drainage system efficiently. Tears then pool on the eye surface and spill over the lid margin, causing watery eyes.
Punctal plugs are small devices placed in the punctum to slow tear drainage and help keep tears on the eye surface longer. They are commonly used for some types of dry eye and can be temporary or longer lasting.
Seek care if tearing is persistent, one-sided, or accompanied by redness, pain, discharge, swelling near the inner corner, or reduced vision. These can suggest infection, significant blockage, or another problem that needs treatment.
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Anatomy, Head and Neck: Eye Lacrimal Duct. StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK531487/. Date Accessed February 5, 2026.
Tear System. Cleveland Clinic. https://my.clevelandclinic.org/health/body/22850-tear-system. Date Accessed February 5, 2026.
Nasolacrimal Duct Obstruction. StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK532873/. Date Accessed February 5, 2026.