Blocked tear ducts, medically known as congenital nasolacrimal duct obstruction or Dacryostenosis, are a common occurrence in infants, affecting one or both eyes in approximately 6% of newborns [1].
In this article, we will explore what blocked tear ducts are, why they occur, their symptoms, and how they can be effectively managed.
Additionally, Dr Heitner will provide detailed explanations on how to perform a nasolacrimal duct massage, clean the eye, and discuss red flags to watch out for.
What are Blocked Tear Ducts?
Tears, produced in the lacrimal gland located behind the upper eyelids, play a crucial role in maintaining healthy eyes.
They keep the eyes lubricated, clear off dust, microorganisms, and other particles, and contain antibodies that protect the eyes from infections.
Normally, tears drain from the eyes through small openings called puncta located in the inner corners of the upper and lower eyelids. These tears then travel through tiny tubes called tear ducts or nasolacrimal ducts and eventually drain into the nose.
This is why you have a runny nose when you start to cry.
However, in some babies, these tear ducts may be partially or completely blocked, preventing tears from properly draining from the surface of the eye into the nose. This blockage can lead to excessive tearing, eye discharge, and other symptoms.
Causes of Blocked Tear Ducts:
Blocked tear ducts in babies are typically caused by a failure of the thin membrane at the end of the tear duct to open fully at birth. This obstruction prevents tears from draining normally into the nose.
Other less common causes include a narrow tear duct system and infections.
Signs of Blocked Tear Ducts:
Signs of a blocked tear duct in babies may include:
- Watery eyes.
- Excessive tearing that runs down the cheeks.
- Redness of the eyelids.
- Crusty eyelashes upon waking.
- Discomfort or irritation around the eyes.
The severity of these signs may worsen during a cold or when outdoors in a windy or cold environment due to increased tear production.
It's essential to note that blocked tear ducts typically do not cause redness of the white of the eye, which is commonly seen in conjunctivitis (pink eye).
Additionally, while blocked tear ducts are a congenital condition, it may not be evident at birth because infants do not produce enough tears until several weeks after birth.
Diagnosis:
The condition is diagnosed based on the medical history and physical examination. No additional tests are usually required to confirm the diagnosis.
Treatment Options:
The good news is that in most cases, blocked tear ducts in babies resolve on their own within the first year of life as the membrane at the end of the tear duct gradually opens.
It is recommended to regularly clean the eyelids and massage the tear duct, to help prevent secondary infection and promote tear duct opening.
Nasolacrimal Duct Massage (Crigler massage):
This technique may help clear any blockage in the tear ducts. Follow these steps to perform the massage:
- Wash your hands thoroughly with soap and water before and after the massage. Ensure that your fingernails are trimmed short to prevent any discomfort.
- Position the tip of your index finger against the side of your child’s nose, precisely in the corner of the eye where the tear duct is blocked (refer to the attached photo for guidance).
- Apply moderate to firm pressure and slide your finger downward approximately 1-2 centimetres.
- Repeat this motion 3 to 5 times during each session.
- Aim to perform these steps 2 to 3 times daily for optimal results.
Cleaning the eyes:
Blocked tear ducts can lead to the accumulation of yellow or green discharge in the eye, causing irritation and increasing the risk of infection. To prevent this, regularly clean the eyelids using the following method:
- Put 1 teaspoon of ordinary table salt into a clean cup.
- Add 250ml of boiling water and stir to dissolve the salt. Allow the solution to cool to room temperature.
- Soak a clean, soft washcloth or cotton ball with the saltwater solution and test its temperature to ensure it is comfortable for use on the eyelids.
- Apply the soaked washcloth or cotton ball to the eyelid, gently wiping from the inner corner of the eye (near the nose) to the outside corner of the eye to remove any yellow discharge.
Alternatively, you can use a commercial saline solution or commercially available eye wipes such as Little Eyes® gentle cleansing eye wipes or Bunjie Probiotic Baby Eye Wipes.
Another option is to use breast milk to remove eye discharge. Some evidence suggests that it can even treat eye infections [2].
Antibiotic eye drops:
If the eyes become infected, with symptoms such as redness of the white of the eye or worsening discharge, a short course of antibiotic eye drops or ointment, such as Chlorsig (which contains Chloramphenicol), may be necessary. These medications can be obtained from your GP or paediatrician.
In rare cases, the tear duct can become infected, a condition known as dacryocystitis. If this occurs, you may notice a firm, red, and painful lump at the side of the nose, often accompanied by increased discharge from the affected eye. If you observe these symptoms in your child, it is crucial to contact your doctor urgently. Treatment typically involves oral or intravenous antibiotics to effectively manage the infection.
Surgical interventions:
In cases where the ducts do not open spontaneously, surgical probing may be required. During this procedure, an ophthalmologist inserts a probe into the nasolacrimal duct to open it. Typically performed under general anaesthesia, this procedure aims to facilitate tear duct drainage and has a high success rate.
Alternatively, other procedures like balloon dilatation of the tear duct or the placement of a temporary silicone stent in the tear duct may be considered in certain cases.
When to Seek Medical Advice:
While blocked tear ducts are common and often resolve on their own, parents should seek medical advice if they notice any of the following symptoms:
- Worsening eye discharge.
- Redness in the whites of the baby's eyes (Conjunctivitis).
- Presence of a hard, red, and painful lump at the side of the baby's nose, which may indicate infection of the tear duct (dacryocystitis).
- Swelling around the baby's eye.
- Lack of improvement in the blocked tear duct by the age of one year.
If any of these symptoms are observed, it is important to consult a healthcare provider for further evaluation and appropriate management.
Summary:
Blocked tear ducts, also known as congenital nasolacrimal duct obstruction or Dacryostenosis, are common in infants, affecting approximately 6% of newborns. This condition arises from a failure of the thin membrane at the end of the tear duct to fully open at birth, resulting in symptoms such as watery eyes, excessive tearing, eye discharge, eyelid redness, crusty eyelashes, and eye discomfort.
Most cases of blocked tear ducts resolve without medical intervention within the first year of life. It is recommended to regularly clean the eyelids and massage the tear ducts to prevent secondary infection and promote tear duct opening. In cases of infection, antibiotic eye drops may be necessary. Parents should seek medical advice if symptoms worsen or persist beyond age one.
Written by Dr Samuel Heitner