Blocked tear duct in infants How to treat and improve the eye

Nasolacrimal duct obstruction in newborns is a common condition that can cause constant tearing, eye redness, and mucous discharge. Most cases improve over time or with simple exercises, but some infants may require medical intervention or a minor procedure. In this Dalily Medical article, we will discuss the causes of nasolacrimal duct obstruction in infants, non-surgical treatment methods, when surgical intervention is necessary, and tips to ensure the eyes improve quickly and safely.

❓ Is Nasolacrimal Duct Obstruction Present at Birth?

Yes, most cases are congenital. This means the baby is born with an incompletely developed tear duct or a thin membrane that prevents proper drainage of tears.

❓ Is the Condition Temporary or Does It Need Treatment?

In many children, the duct opens on its own during the first year. If not, treatment may include:

Gentle eye massage
In some cases, a minor surgical procedure

❓ How Can I Tell if My Baby Has a Blocked Tear Duct?

Look for:

Constant tearing in one or both eyes
Yellow or white discharge
Eyelids sticking together after sleep
Recurrent eye infections
If these signs are present, the child should see a pediatric ophthalmologist.

❓ Is There a Risk if Treatment is Delayed?

Not always, but repeated infections or abscesses around the eye require medical intervention to prevent complications.

❓ Is Massage Alone Effective?

Sometimes, regular massage around the tear sac helps open the duct, especially during the first 6 months of life.

❓ How Can I Help My Baby at Home Without Surgery?

Clean discharge with a sterile tissue or cotton ball moistened with warm water
Gently massage the inner corner of the eye 2–4 times daily as advised by your doctor

❓ When Does the Baby Need Surgical Intervention?

If the duct does not open after 1 year despite conservative attempts like massage or eye drops, the doctor may recommend a simple procedure to open the duct.

❓ Can the Obstruction Come Back After Treatment?

Rarely, but it can. If it recurs, the doctor will re-examine the child and decide on the appropriate treatment.

❓ When Should I See the Doctor Immediately?

If the obstruction persists after 1 year
If there is severe eye infection (redness, swelling, excessive discharge, or fever)

❓ Are There Any Medications That Can Help?

Sometimes, the doctor prescribes antibiotic eye drops if infection occurs, but there is no medication that opens the duct itself. The primary treatment is massage and monitoring.

❓ What Are Blocked Tear Ducts?

The tear ducts (nasolacrimal ducts) are small tubes that drain tears from the eyes into the nose. If blocked, tears cannot drain properly, causing:

Excessive tearing
Eye discharge
Irritation or redness

This condition affects about 5–10% of newborns. Most cases improve on their own before age 1, but some children may need medical intervention.

❓ Is Massage Effective?

Yes, regular, proper massage from the first months of life is sufficient in many cases.

❓ What if the Duct Remains Closed After 1 Year?

The doctor may suggest opening the duct using a small probe. The procedure is very simple, performed under light anesthesia, and usually has excellent results.

Types of Nasolacrimal Duct Obstruction in Infants

The type of tear duct blockage depends on the cause and the location of the obstruction, which helps the doctor determine the proper treatment. The main types are:

✅ 1. Congenital Nasolacrimal Duct Obstruction

Most common in newborns
Caused by a thin membrane covering the end of the duct at the nose (Hasner’s membrane)
Sometimes the blockage occurs elsewhere in the duct (less common)
Incidence: About 6–20% of newborns; usually resolves on its own within the first year

✅ 2. Acquired Obstruction

Occurs after birth due to other factors, such as:
- Recurrent eye or nasal infections
- Trauma to the face
- Abnormal growth in the nose or tear ducts
- After surgery or birth complications

Symptoms of Blocked Tear Ducts in Children

Excessive tearing: Eyes may constantly water even without crying, tears may run down the cheeks
Eye discharge: Yellow or white sticky discharge, especially after naps, can cause mild infections
Redness or irritation around the eyes
Crusting of the eyelids: Dried discharge may stick to eyelashes or eyelids, making it difficult to open eyes, especially after sleep
Usually affects one eye, but sometimes both ducts are blocked
⚠️ Symptoms may worsen in cold, windy, or dusty conditions

Causes of Nasolacrimal Duct Obstruction in Newborns

❖ Incomplete development of the tear duct at birth
The nasolacrimal duct may still be closed or have a thin membrane, causing:

Yellow or green discharge
Constant tearing even without crying
Occasional eyelid inflammation

Other less common causes:

Congenital defects in duct formation (severe narrowing or absence of parts)
Infections during birth (e.g., bacterial conjunctivitis)
Birth trauma (use of vacuum or forceps)
Small cyst or tumor blocking the duct (very rare)

Diagnosis of Nasolacrimal Duct Obstruction in Children

Diagnosing nasolacrimal duct obstruction is usually straightforward through a clinical eye exam. However, sometimes additional tests are needed to confirm the diagnosis or rule out other problems.

Clinical Examination
The doctor examines the child’s eyes and asks about:

Constant tearing without an obvious cause
Mucous or pus-like discharge
Mild redness around the eye
Recurrent eye infections
The doctor also checks for any mild swelling in the inner corner of the eye.

Reflux Test
The doctor gently presses the tear sac, and if discharge comes out from the eye, this may indicate a blocked duct.
Fluorescein Dye Disappearance Test
A special dye is placed in the eye. If it remains for a long time and does not drain with the tears, this suggests a possible blockage.
Imaging (in rare cases)
If the condition does not improve or the doctor suspects a more complex cause, imaging tests such as Dacryocystography may be requested.

Complications of Nasolacrimal Duct Obstruction in Children

If the obstruction persists or treatment is delayed, several complications can occur:

Dacryocystitis (Inflammation of the Tear Sac)

Cause: Accumulation of tears and bacterial growth in the tear sac
Symptoms: Redness, pain in the inner corner of the eye, swelling, yellow discharge, and sometimes fever

Recurrent Conjunctivitis

Repeated eye infections with redness, constant tearing, and annoying discharge

Chronic Tear Sac Cyst

Persistent obstruction can cause a chronic enlargement of the tear sac, leading to discomfort or pressure

Vision Impairment (rare)

Excessive tears and discharge may interfere with the child’s vision, especially if infections are frequent

Abscess Formation (rare)

Severe untreated infections can lead to an abscess around the tear sac

Treatment of Nasolacrimal Duct Obstruction in Infants

In most cases, the tear ducts open spontaneously within the first 9 months after birth, which is natural and usually requires no intervention.

If the obstruction persists, a pediatric ophthalmologist may recommend a precise medical intervention, especially before 9 months of age, and it should always be performed by an experienced doctor.

Treatment Options if the Obstruction Persists After 9 Months

Probing the Tear Duct

The doctor passes a very thin probe through the tear duct and flushes fluid to confirm the duct is open
High success rate if done before age 3
Performed under general anesthesia and takes a short time

Silicone Tube Intubation

A small silicone tube is placed in the duct for about 6 months
Simple procedure with a success rate over 80%, especially if probing fails

Balloon Dacryoplasty

A small balloon catheter is inserted and inflated inside the duct to widen the tear drainage
High success rate similar to silicone tubes, but more expensive

Surgery (Dacryocystorhinostomy)

If all other methods fail, a small incision is made between the eye and nose to place a new tube
Performed under general anesthesia
Highest success rate among all treatments