Nasolacrimal Duct Obstruction in Babies

Do your newborn’s eyes look watery or crusty, even when they aren’t actually crying? Excessive tearing or the presence of mucous in your baby’s eyes may indicate a blocked tear duct, medically known as nasolacrimal duct obstruction.
More than 5 percent of infants are born with tear duct obstruction in one or both eyes, most often because the membrane covering the duct has not opened before birth or the ducts are still too narrow.
Normal tears are essential to continuously moisturize and lubricate the eyes while flushing out bacteria. Tears drain through small openings in the inner corners of the eyelids that connect to the nose through the tear ducts. If your baby has a blocked duct, tears may well up on the surface of the baby’s eyes, overflowing onto the eyelids and cheeks. You may also see signs of inflammation or infection such as eye redness or yellowish discharge due to inadequate drainage of the eye. Symptoms often get worse if your baby is congested or exposed to cold, wind or bright sunlight.
A blocked tear duct alone will not damage your baby’s vision. However, it may cause an infection, which can be a serious risk. If you suspect a blocked duct or see any of these signs, consult your baby’s doctor:
Watery, runny or crusty, sticky eyes
Redness or swelling of the eyelids
Yellowish-green discharge from the eye
Tenderness or pain
In most babies—more than 90 percent—tear duct obstruction resolves on its own before the age of one because the membrane opens or the eye drainage system matures. In the meantime, your doctor may suggest a gentle massage technique to help unblock the flow of tears. By using a warm cloth and gently massaging the lower eyelid from the outside inward, you can sometimes help to open up the duct and let the tears flow freely. A topical antibiotic may also be prescribed to prevent or treat infection.
If your baby’s blockage persists, it is almost always correctable with a simple procedure that is usually performed after at least six months of age.  An eye specialist will use a thin, wire-like probe to open the duct. Probing may be performed either in the doctor’s office or in a surgical facility, where a light general anesthesia can be used to ensure the baby remains still. Complications are rare, since probing success rate is more than 90 percent. Occasionally, more involved surgery is required to unblock the duct.

Reviewed by Dr. Sara Connolly, December 2018
Sources:

• Pediatric Eye Disease Investigator Group, Petersen DB, Chandler DL, Repka MX, et al.  Resolution of congenital nasolacrimal duct obstruction with nonsurgical management
• Arch Ophthalmol
• 2012 June;130(6):730-734. Pediatric Eye Disease Investigator Group, Repka MX, Chandler DL, et al.  Primary treatment of nasolacrimal duct obstruction with probing in children younger than 4 years
• Ophthalmology
• 2008 Mar;115(3):577-584.

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