Blocked Tear Duct in Children

Blocked Nasolacrimal Duct Symptoms, Diagnosis, and Treatment

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A blocked tear duct occurs when the nasolacrimal duct, which drains tears from the eye into the nose, gets blocked (because of infection, trauma, etc.) or, more commonly, is blocked from birth (congenital nasolacrimal duct obstruction).

baby with tears as seen with blocked tear ducts
Istockphoto.com/Stock Photo©BrianAJackson

Causes

Newborns and younger infants commonly have some matting in their eyes and may have a lot of tearing. Although often blamed on pink eye, watering eyes without symptoms such as red eye are more commonly caused by a blocked tear duct, something referred to as dacryostenosis.

The most common cause of nasolacrimal duct obstruction in newborns is a failure of the membrane guarding the duct—the valve of Hasner—to open. Children can have a blocked tear duct affecting either one or both eyes.

It is estimated that up to 30% of newborns are born with a blocked tear duct, but in over 90% of these children, the symptoms resolve by their first birthday.

Symptoms

Infants with a blocked tear duct will often:

  • Have teary eyes, so that their eyes always seem extra moist or simply seem to produce a lot of tears (epiphora) that drain onto the child's cheeks
  • Have eyes that appear crusted and matted with discharge, because mucoid material that is normally produced in the lacrimal sac backs up onto the eye, instead of draining through the nasolacrimal duct to the nose
  • Have some redness around their eyes because these children often rub their eyes

Although children with a complete blockage will always have symptoms, if your child has a partial blockage, you may only notice the symptoms when they're making extra tears or if the nose is blocked, like when they has a cold.

Most children with a simple blocked tear duct don't have other symptoms. Watch for signs of infection around the tear duct, including:

  • Swelling
  • Redness
  • Pain
  • Fever

These symptoms may indicate an infected nasolacrimal sac, which is in the corner of your child's eye. This condition is called dacryocystitis.

Diagnosis

Children are usually diagnosed with a blocked tear duct based on the pattern of symptoms, including excessive tearing and matting.

Keep in mind that many newborns don't start making tears until they are about two weeks old or a little older, so you may not notice any symptoms of a blocked tear duct, even if your baby is born with it.

If your younger child is repeatedly diagnosed with pink eye, especially if their eye is not usually red, then they may have a blocked tear duct.

Occasionally, a modified fluorescein dye disappearance test may be done.

A fluorescein dye is placed on your child's eye. After 5 minutes, a black light is used to see if all of the dye has disappeared through the tear ducts and into the nose. If the dye remains, the tear duct is likely blocked.

Congenital Glaucoma

If your child's eye is tearing, they're fussy and irritable, and the cornea looks dull and cloudy, your doctor may check for congenital glaucoma rather than a blocked tear duct.

Congenital glaucoma is uncommon (1 in 10,000 births) and occurs most often in the first 2 years of life. It's important that this disorder is accurately diagnosed, as proper treatment can usually preserve vision.

Treatment

Fortunately, most cases of blocked tear ducts go away on their own. Until it does, treatments can include:

  • Nasolacrimal massage (massaging the inside corner of your child's nose, as directed by a doctor) 2 to 3 times a day, which studies suggest may reduce the need for nasolacrimal duct probing
  • Cleaning any discharge or matter in the eyes with a warm washcloth
  • Antibiotic eye drops if discharge becomes excessive (if you have to wipe it away more than 2 or 3 times a day)
  • Oral antibiotics if your child develops symptoms of dacryocystitis

If the blocked tear duct does not go away on its own, especially by the time your child is 9 to 12 months old, nasolacrimal duct probing may be necessary.

In this procedure, which is usually very successful, a pediatric ophthalmologist (eye doctor for children) will insert a probe into the nasolacrimal duct, attempting to clear anything that is blocking the duct.

If probing is done early before a child is 6 to 8 months old, it can often be done by a pediatric ophthalmologist in their office, without general anesthesia, which would be necessary for older children.

Occasionally, a canalicular stent, a silicone tube, is placed into the nasolacrimal duct if it continues to get obstructed.

A pediatric ophthalmologist can be helpful when your child has a blocked tear duct, although your pediatrician can likely manage most simple cases.

A Word From Verywell

Don't hesitate to see your pediatrician if you suspect a problem with your baby's eyes or tear ducts. Proper diagnosis and treatment can make your child feel better and safeguard their vision.

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Article Sources
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  1. American Academy of Ophthalmology. Nasolacrimal Duct Obstruction in Children. Updated November 15, 2015.

  2. American Association for Pediatric Ophthalmology & Strabismus. Glaucoma for Children. Updated September 2018.

  3. Karti O, Karahan E, Acan D, Kusbeci T. The natural process of congenital nasolacrimal duct obstruction and effect of lacrimal sac massage. Int Ophthalmol. 2016;36(6):845-849. doi:10.1007/s10792-016-0208-5