Pediatric Views

June 2006

Blocked tear ducts in infants

By Children's Hospital Boston ophthalmologist Deborah VanderVeen, MD

What are blocked tear ducts?
A blocked tear duct is a fairly common and usually temporary problem that occurs in infants when the nasolacrimal duct—the passage that lets tears drain from the eye into the nasal cavity—becomes obstructed or is closed off.

Having blocked tear ducts does not mean that you don't make tears. It actually means that the drainage system is blocked, so the tears that are made can't drain out, and the eye becomes flooded.

Blocked tear ducts occur in up to 20 percent of newborns. The condition, called dacryostenosis, can affect just one eye or both. For some babies, blocked tear ducts aren't immediately evident at birth and may not be noticed until the baby is a month old.

What are the symptoms?
When an infant has a blocked tear duct, the eye looks wet or tears may spill over onto the cheek, even when he or she is not crying. There is often mucoid material, a mucus-like substance, on the edges of the eyelid.

What causes blocked tear ducts?
Normally, tears are produced by the lacrimal gland and then move across the eyes with the help of the eyelids, to keep eyes lubricated and clean. When a person blinks, the tears are squeezed into the ducts in the inner corner of the eye. They then drain out of the eyes down small tubes—nasolacrimal ducts—into the back of the nose. Sometimes the ducts have not fully opened by birth, so tears cannot properly drain out of the eye.

For most children born with a blocked tear duct, there is only a small membrane blocking the opening, which opens spontaneously as the infant grows. Usually the membrane opens by 10 to 12 months of age.

How is it treated?
Since the majority of cases resolve without treatment, most doctors suggest waiting to see if the duct opens on its own. There is spontaneous remission in 95 percent of cases by age 1.

In the meantime, doctors typically recommend keeping the eye clean, and may prescribe an antibiotic eye ointment to help reduce the discharge from the eye. Often, health care providers recommend massaging the lacrimal sac—the upper portion of the nasolacrimal duct, near the inner corner of the eye—hoping it will help open the membrane. However, if there is no build-up of fluid or distention of the lacrimal sac from this excess fluid, which is the case for most babies, the massaging won't help much and probably isn't necessary.

If the condition doesn't resolve itself, a quick outpatient procedure, called a probe and irrigation is done. It's performed under brief, general anesthesia so the child is comfortable. A small metal instrument is passed through the nasolacrimal duct to open the membrane. This procedure cures more than 90 percent of the cases that haven't resolved on their own.

In the rare situation that the probing doesn't help, other measures, such as the placement of tubes, using a balloon instrument to stretch the opening, or surgery to create a new passage between the tear sac and the nose, can be done. But it's usually not necessary. While there's no debate about how to treat blocked tear ducts, there is some controversy about when to perform a procedure.

While most doctors wait to see if the problem resolves itself, some prefer to do a probing procedure early on. The advantage to doing the procedure earlier is that it can be done in the office with only topical anesthesia, since a young infant can be swaddled and more easily restrained. When a child is already a year old, general anesthesia is usually necessary for the procedure to be safe and comfortable.

This article was adapted from content provided by Children's Hospital Boston to Yahoo! Health. For more pediatric health information from Children's, visit health.yahoo.com/topic/parenting.

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