Blocked Tear Ducts (NLDO)

Goopy eyes are common in newborns (up to 5%) with excessive tear drainage and discharge from the eyes.  This is most often caused by a Nasolacrimal Duct Obstruction (NLDO), a blockage of the tear duct that drains the tears off of the eye and down into the nose.

The blockage is usually at the bottom end of the tear duct where it should open into the nose.  Although a NLDO can have some concerning looking discharage, it is usually not an actual infection.  Instead, bacteria in the stagnant tears in the blocked tear duct multiple and produce discharge which backs up into the eyes.  In this case, the eyes themselves are healthy & white, as opposed to conjunctivitis (pink eye) where the eyes will get red in addition to the discharge.  Antibiotic eye drops or ointments may help the symptoms temporarily by killing the bacteria but do not solve the underlying plumbing problem.  Therefore, the symptoms will usually return when the antibiotic eyes drops are discontinued.

When should NLDO be evaluated?

It’s essential for your pediatrician or pediatric ophthalmologist to determine that there is not a more serious infection present, such as some types of neonatal conjunctivitis or dacryocystitis (tear sac infection).  Your pediatrician will likely refer you for an initial evaluation to discuss treatment options when the baby is 6-9 months old.  Evaluation the eye sooner is a good idea if there is associated eye redness, significant skin irritation, or redness/swelling around the eye.

A mild case of NLDO might cause just excessively water eyes.  However, watery eyes without discharge in an infant is also a potential symptom of infantile glaucoma, which must be evaluated and treated right away.

How is NLDO treated?

Many babies will have a NLDO to some degree in the first few weeks of life, but most of these will clear quickly.  Around 90% of blockages resolve on their own before the child is one year old.  So initial treatment usually just involves gently wiping away discharge with a warm moist cloth and using antibiotic eye drops when needed for really bad discharge.  Massaging the child’s tear sac at home might help open up the blockage.  Tear sac massage involves forcing pressure down the tear duct to help open the obstruction.  Gentle but firm pressure is placed above the inside corner of the eye and then moved downwards below the inside corner.  This is repeated 10-20 times a session once or twice a day.

If the child’s symptoms do not improve by 10-12 months of age (or earlier for extreme symptoms), then your pediatric ophthalmologist can open the nasolacrimal duct to clear the obstruction by performing a probing.  This can be completed under a brief anesthesia and there is usually no pain afterwards.  Sometimes a silicone stent tube may be left in the tear duct for a few months to keep it open as it heals.  This is easily removed in the office weeks to months later.  A probing with or without stent placement is successful on the first time 90-95% of the time.

To schedule an appointment, call (509) 456-0107