A blocked tear duct, medically known as nasolacrimal duct obstruction (NLDO), is a frequent condition in infants. This occurs when the tear drainage system, running from the corner of the eye into the nose, is partially or completely blocked. Tears are produced in the lacrimal glands and typically drain through tiny openings in the eyelids, but a blockage prevents this flow, causing tears to back up. For most babies, this issue is temporary and results from the valve of Hasner, a thin membrane, failing to open fully at birth. Up to 20% of newborns may show symptoms, but the condition generally resolves on its own within the first year of life.
Identifying the Symptoms and Cause
The primary reason for a blocked tear duct is the presence of residual tissue, the valve of Hasner, which did not dissolve completely after birth. This membrane prevents the proper flow of tears from the eye into the nasal cavity. Since the tears cannot drain, they accumulate in the lacrimal sac and overflow onto the cheek.
The most common symptom is excessive tearing, or epiphora, where the eye appears constantly watery even when the baby is not crying. This pooling of tears leads to a sticky discharge or “gunk” around the eye. This discharge can result in crusting on the eyelashes and eyelids, particularly after the baby wakes up.
The constant dampness and discharge can sometimes cause mild redness or irritation of the surrounding skin and eyelid. If the white part of the eye becomes significantly red, or if there is swelling or thick yellow/green pus, this may signal a secondary infection requiring medical attention. Symptoms typically begin to appear within the first few weeks to two months of life once the infant’s tear production increases.
Step-by-Step Tear Duct Massage
The most recommended home treatment is the Crigler massage, which increases pressure in the tear duct system to potentially open the obstructing membrane. Before beginning, wash your hands thoroughly with soap and water to prevent introducing bacteria to the baby’s eye area. Any crusted discharge around the eye should be gently cleaned away using a clean, soft cloth dampened with warm water.
To perform the massage, place the tip of your index or pinky finger on the side of the baby’s nose, next to the inner corner of the eye. Apply pressure over the lacrimal sac, located in the bony area where the eyelids meet the nose. Apply gentle but firm pressure inward, pressing back toward the inner corner of the eye socket.
Once pressure is applied, roll or slide your finger in a short, downward stroke along the side of the nose, moving toward the cheekbone. This movement creates a wave of hydrostatic pressure within the tear duct, forcing trapped fluid and mucus down against the membrane. This downward force encourages the valve of Hasner to open.
Repeat this inward and downward stroke five to ten times in a single session, performing the massage at least three to four times throughout the day. Good times to perform the massage are during diaper changes or after a warm bath when the baby is relaxed. Consistency is beneficial, as the goal is to keep applying pressure over several months to encourage the natural opening of the duct.
Medical Treatment Options and When to Seek Help
While home massage is the initial management, parents must be vigilant for signs that the condition is escalating. A secondary bacterial infection, known as dacryocystitis, can occur when stagnant tears and mucus create a breeding ground for germs in the tear sac. Signs of this infection include significant swelling and redness between the eye and the nose, or a sudden increase in thick, pus-like discharge, which warrants immediate consultation with a pediatrician.
If massage has been consistently performed for several months without success, or if the blockage persists beyond the baby’s first birthday, medical intervention is typically considered. Spontaneous resolution rates decrease significantly after 9 to 12 months of age, and the success rate of a simple procedure declines after 15 months. The most common medical procedure is lacrimal duct probing, where an ophthalmologist passes a thin, sterile wire through the tear duct to puncture the membrane obstruction.
This procedure, which has a success rate over 90% when performed before 12 months, is usually quick and may be done in an office setting or under light sedation. For blockages that are more complex or fail to resolve after probing, other options exist, such as balloon catheter dilation or temporary silicone tube insertion. Regular follow-up with the doctor is important to monitor the condition and determine the appropriate time for professional intervention.