Posted on October 01, 2017
Blocked Tear Ducts in Babies
By: Jeffrey Colburn, MD
Goopy eyes are a common annoyance in newborns. This is most often caused by a Nasolacrimal Duct Obstruction (NLDO), which is a blockage of the tear duct that drain tears out of the eye and down into the nose. The blockage most often happens at the bottom end of the duct where it should open into the nose. Although an NLDO can have some nasty looking discharge, it is not truly an infection. Rather, bacteria that are sitting in the stagnant tears in the blocked tear duct help make the goop and it backs up back into the eyes. In this case the eyes themselves are nice and white, as opposed to the conjunctivitis (pink eye) where the eyes will get red in addition to the discharge.
Many babies will have a NLDO to some degree in the first few weeks of life and most of these will clear quickly. For those with a persistent blockage longer, most will still resolve spontaneously by a year of age. Antibiotic eye drops can be used temporarily if needed, though these do not actually fix the “plumbing” problem with the blocked tear duct. Tear sac massage can be done at home and might help open up the blockage. For cases where there is not improvement close to a year of age, or earlier for extreme symptoms of skin irritation from copious discharge, we can a procedure under a brief anesthesia to clear the blockage and restore normal tear drainage flow. On occasion a tear duct stent might be left in place for a few months to keep the duct open if it feels significantly tight. These procedures are safe, quick, and successful more than 90% of the time.
Your pediatrician will likely refer you for an initial evaluation and discussion of options when the baby is between 6-9 months old. A sooner evaluation would be warranted for associated eye redness or significant skin irritation, redness or swelling around the eye. It is also important to note that a mild case of NLDO might result in just excessively watery eyes. However, watery eyes without discharge in an infant is also a potential symptom of infantile glaucoma, which needs to be evaluated and treated right away.