Nasolacrimal Duct Obstruction, Infant

Eyes are cleaned and made moist (lubricated) by tears. Tears are formed by the lacrimal glands which are found under the upper eyelid. Tears drain into two little openings. These opening are on inner corner of each eye. Tears pass through the openings into a small sac at the corner of the eye (lacrimal sac). From the sac, the tears drain down a passageway called the tear duct (nasolacrimal duct) to the nose. A nasolacrimal duct obstruction is a blocked tear duct.

CAUSES

Although the exact cause is not clear, many babies are born with an underdeveloped nasolacrimal duct. This is called nasolacrimal duct obstruction or congenital dacryostenosis. The obstruction is due to a duct that is too narrow or that is blocked by a small web of tissue. An obstruction will not allow the tears to drain properly. Usually, this gets better by a year of age.

SYMPTOMS

  • Increased tearing even when your infant is not crying.

  • Yellowish white fluid (pus) in the corner of the eye.

  • Crusts over the eyelids or eyelashes, especially when waking.

DIAGNOSIS

Diagnosis of tear duct blockage is made by physical exam. Sometimes a test is run on the tear ducts.

TREATMENT

  • Some caregivers use medicines to treat infections (antibiotics) along with massage. Others only use antibiotic drops if the eye becomes infected. Eye infections are common when the tear duct is blocked.

  • Surgery to open the tear duct is sometimes needed if the home treatments are not helpful or if complications happen.

HOME CARE INSTRUCTIONS

Most caregivers recommend tear duct massage several times a day:

  • Wash your hands.

  • With the infant lying on the back, gently milk the tear duct with the tip of your index finger. Press the tip of the finger on the bump on the inside corner of the eye gently down towards the nose.

  • Continue massage the recommended number of times a day until the tear duct is open. This may take months.

SEEK MEDICAL CARE IF:

  • Pus comes from the eye.

  • Increased redness to the eye develops.

  • A blue bump is seen in the corner of the eye.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Swelling of the eye or corner of the eye develops.

  • Your infant is older than 3 months with a rectal temperature of 102° F (38.9° C) or higher.

  • Your infant is 3 months old or younger with a rectal temperature of 100.4° F (38° C) or higher.

  • The infant is fussy, irritable, or not eating well.