Tearing and Your Baby (Nasolacrimal Duct Obstruction)

Most infants who have a blocked tear duct during the first year of their life will get better without any treatment. Babies enter the world with a cry but they do not begin producing tears until about three weeks later. Tears which are necessary for the natural lubrication of the eyes flow through a series of drainage channels that carry the fluid into the nose.

Babies who have noticeable watering of the eyes – with tears overflowing from the lids onto the cheeks – probably have a blockage in their tear drainage system. This problem is very common occurring in about one in three babies. In 6 to 20 per cent of those babies there are noticeable symptoms. Most cases resolve completely within the first year of life. If not the blockage can be opened with gentle massage or with a simple treatment.

Symptoms of Blocked Drainage

The eyes may water excessively even when your baby is not crying and the eyelashes may have crust and mucous on them particularly in the morning. If there is an infection which can result from the abnormal backup and pooling of tears the eyes may become red and the lids may swell perhaps with a thick yellowish-white discharge. The symptoms of a blocked tear duct may get worse after a sinus or upper respiratory infection. Also they may be more noticeable after the baby has been exposed to wind and cold because these may cause increased production of tears.

What Causes the Tearing?

Tears normally drain from the eyes through tiny tube-like channels called canaliculi which are located under the skin at the inner corner of the eyelids. These channels carry the tears into the tear sac near the side of the nose and then into the tear duct which empties into the nose (that’s one reason your nose runs when you cry).

In most newborns there is a thin membrane covering the tear duct where it enters the nose. This membrane usually opens within the first six weeks of life but in some babies it doesn’t open until much later. In others the membrane needs some help becoming unblocked.

Treatment

Most infants who have a blocked tear duct during the first year of their life will get better without any treatment. But you can help speed up the process by massaging carefully over the tear sac. If excessive mucous production or eye infections accompany the tearing antibiotics may also be prescribed.

How to massage: Find the tear sac by placing your index finger firmly on the inner corner of the baby’s eyelids near the nose. You will feel a ridge of bone under your finger. Press down gently but firmly toward the nostril and hold it (do not rub) for 3 to 4 seconds. Do this three or four times a day making sure your hands are freshly washed and fingernails are short. If you do not understand these instructions someone in the office will go over them with you.

What Is a Probing?

If the tearing problem does not improve after allowing sufficient time for the natural opening process and the massaging to work or if your baby has frequent eye infections the tear duct may need to be probed. This procedure involves a thin metallic rod being gently slipped into the tear duct and pushed through the membranous block. The probe acts like a pipe cleaner to remove the obstruction.

This is a painless minor procedure that usually takes less than five minutes. If your baby is older than six months the procedure will probably be performed in the hospital operating room since general anesthesia may be needed to keep the baby from moving while the delicate channels near the eyes are being probed.

Except for the time in the operating and recovery rooms you will be able to stay with your baby and he or she can go home with you the same day. Occasionally a baby develops a mild nosebleed after returning home. If bleeding is any more than a few drops please call the office right away. Probing is about 90 to 95% effective and is an extraordinarily safe procedure. For those few infants in which probing fails a second probing may be attempted or silicone tubes may be placed in the tear duct until an open passageway is secured usually about three to six months after placement.

Prognosis

The majority of obstructions will open spontaneously by the time your baby is one year old. If this is not the case nasolacrimal duct probing is usually performed. This procedure is generally quite safe and can often provide an immediate cure. In a very small number of babies it may not work because of some other abnormality of the tear drainage system. In that case additional procedures will be required to allow tears to drain properly. If any type of surgical procedure is recommended for your baby the risks present with any surgery and anaesthesia will be carefully explained to you along with the potential benefits. Fortunately tearing problems are almost always managed simply and successfully. Being born with a blocked tear duct does not mean that a baby will have other congenital eye problems.