A blocked tear duct, medically known as a congenital nasolacrimal duct obstruction, is a very common condition in infants. The tear drainage system runs from the eye surface down into the nose. When this pathway is blocked, tears cannot flow out properly, causing them to back up onto the eye’s surface. This condition is generally benign and resolves completely on its own in approximately 90% of affected babies, typically within the first year of life as the duct naturally matures and opens.
Identifying a Blocked Tear Duct and Common Causes
The most noticeable sign of a blocked tear duct is epiphora, or excessive watering of the eye, even when the baby is not crying. Tears pool on the eye’s surface and spill over onto the cheek. Parents may also observe a sticky, mucus-like or yellowish discharge that collects in the corner of the eye or crusts the eyelashes, particularly after waking. This discharge occurs because stagnant tears provide a warm, moist environment where normal bacteria can multiply, leading to a low-grade infection.
The blockage is usually developmental, meaning the baby was born with it. The most frequent cause is a thin, residual membrane—known as the Valve of Hasner—that fails to open where the duct meets the nasal cavity. This membrane prevents tears from draining into the nose. The obstruction is congenital and is not typically caused by injury or external infection.
Step-by-Step Guide to Home Care and Massage
The first-line approach for managing a blocked tear duct is nasolacrimal duct massage, which aims to encourage the membrane to open. This simple home intervention can be performed several times daily, typically four to ten times per day, with ten strokes each time. Begin by thoroughly washing your hands to prevent introducing bacteria.
To perform the massage, place the tip of your clean index finger or a clean cotton swab near the inner corner of the baby’s eye, next to the nose. Apply firm but gentle, downward and slightly inward pressure, stroking from the inner eye corner down the side of the nose. The goal is to build hydrostatic pressure within the lacrimal sac, which may help to open the thin membrane.
Maintaining strict hygiene is important to manage the discharge and prevent secondary infections. Use a clean cotton ball or soft cloth dipped in warm, sterilized water to gently wipe the eye clean. Always wipe away from the inner corner toward the outer edge, using a fresh section of the cloth for each swipe to avoid spreading debris. Wash your hands again after the cleaning is complete.
When to Consult a Pediatrician and Medical Procedures
While most blocked tear ducts resolve with home massage and time, specific signs indicate the need for a pediatrician’s consultation. If the baby develops signs of a more serious infection, called dacryocystitis, professional medical attention is necessary. These signs include persistent redness, significant swelling near the inner corner of the eye, fever, or a thick, green or yellow discharge that returns rapidly after cleaning.
A doctor may prescribe antibiotic eye drops or ointment if a secondary bacterial infection is present, though these medications treat the infection and do not fix the underlying blockage. If the condition persists past the baby’s first birthday despite consistent home care, the pediatrician or a pediatric ophthalmologist may recommend a minor procedure.
The most common procedure is lacrimal duct probing, which involves passing a thin, blunt metal wire through the tear duct to break open the persistent membrane. This procedure is usually performed under a brief general anesthetic and is highly successful, with the best results seen between 6 and 18 months of age. If probing is unsuccessful, the doctor may opt for silicone tube intubation, where a small tube is temporarily placed in the duct to hold it open.