Blocked Tear (nasolacrimal) Ducts in Infants
Updated: Aug 7, 2019
Many babies have a watery discharge from one or both eyes for some time after birth. Some are caused by a blockage in one or both nasolacrimal (tear) ducts which run from small openings at the inner corner of the eye to the inside of the nose. It usually affects babies as the duct has not fully opened by birth, in around one in five babies. This means that tears cannot drain away as they should, so tears flow out of the eye and run down the cheeks. It is not known why tear ducts are not fully open when some babies are born. They usually open over the first few weeks and months of life without treatment as the tube (duct) matures and opens.
Tear production does not start immediately after birth, so it may not be noticeable for a week or two. The main symptom is watering eyes, with tears pooling in the corner of the eye, spilling over onto the cheeks when a baby is not crying. Sometimes, the secretions dry up a bit and look like crusts in the corner of the eye and the baby’s eyes may look sticky.
If baby’s eyes are sticky or crusty, this can be gently wiped away using gauze (not cotton wool) and cooled, boiled water. It is often helpful to massage the tear duct up to 4 times a day by using gentle massaging pressure on the outside of the nose, just below the inner angle of the affected eye(s) and a doctor will be able to show you how to do this.
Infrequently, conjunctivitis may occur; the tears become thicker and yellow/green in colour and the eyeball becomes red and inflamed. Antibiotic eye ointment (better than drops) may need to be prescribed. You should also ask for medical advice if your baby seems to be in pain, won’t open his/her eye and seems bothered by light.
If the watery eye problem is still present at a year, you should ask for a referral to a paediatric eye surgeon (Ophthalmologist) to discuss whether your baby’s duct needs probing to unblock it as it is rare for the duct to open spontaneously after a year. This is done with a tiny probe while the baby is under anaesthetic. Occasionally, a tiny drainage tube may be inserted into the duct to keep it open.