Tear duct blockage

Tear duct blockage (or dacryostenosis) is a blockage of the nasolacrimal duct. 

It usually affects babies as the duct has not fully opened by birth in around one in five babies. This means that tears cannot drain away as they should, so tears flow out of the eye and run down the cheeks. Either one or both ducts can be affected.

Tears are the body’s way of keeping the surface of the eye moisturised and free from debris, such as dust or pollen. Tears are formed in the lacrimal gland, which is above the outside corner of the eye, underneath the brow bone.

Each time we blink, tear fluid is swept across the surface of the eye and drains away through tiny channels in the inside corner of the eye. This is called the nasolacrimal duct. Tears drain through the duct into the nose.

What causes tear duct blockage?

We do not know why the tear duct is not fully open when some babies are born. It usually opens over the first few weeks and months or life without treatment.

What are the signs and symptoms of tear duct blockage?

Tear production does not start immediately after birth, so symptoms may not be noticeable for a week or two. The main symptom is watering eyes, with tears pooling in the corner of the eye, spilling over onto the cheeks. This occurs even when a baby is not crying. Symptoms may get worse when the baby has a cold or during cold weather, as tear production increases.

Sometimes, a baby’s eyes may look sticky or crusted when they wake. Occasionally, the eye may look a bit pink, which may be a sign of conjunctivitis or inflammation of the eye covering.

How is tear duct blockage diagnosed?

No special tests are needed to diagnose tear duct blockage. Usually the doctor will look closely at the baby’s eyes and take a medical history.

How is tear duct blockage treated?

Usually the tear duct gradually opens during the first few weeks or months of life. This will stop the eye watering, although they may still be a bit watery during cold weather. If a baby’s eyes are sticky or crusty on waking, this can be gently wiped away using gauze and cooled, boiled water. Sometimes, the doctor may suggest gentle massage to clear the blockage and encourage the duct to open, by pressing gently on the outside edges of the bridge of the nose.

Sometimes, the duct has not opened by the time the baby is one year old. In these cases, the doctor may suggest a procedure to open the ducts using a tiny probe while the baby is under anaesthetic. Occasionally, a tiny drainage tube may be inserted into the duct to keep it open.

What happens next?

Tear duct blockage rarely cases any long term effects.

Compiled by: 
The Eye Department in collaboration with the Child and Family Information Group
Last review date: 
March 2013

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