Blocked Tear Ducts
Nasolacrimal Duct Obstruction (NLDO)
Goopy eyes are a common congenital condition in newborns (up to 5%) which causes excessive tear drainage and chronic discharge from the eyes. It is most often caused by a Nasolacrimal Duct Obstruction (NLDO), a blockage of the tear duct that drains 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 concerning looking discharge, it’s not truly an infection. Instead, bacteria sitting in the stagnant tears in the blocked tear duct help make the “goop” which backs up back into the eyes. In this case, the eyes themselves are healthy and white, as opposed to conjunctivitis (pink eye) where the eyes will get red in addition to the discharge.
What causes NLDO/Blocked Tear Ducts?
The nasolacrimal duct (tear duct) normally drains tears away from the eye from the tear sac down through the nasal bones and into the nose. Some children are born with a membrane still covering the opening at the nose end of the tear duct that should have opened up at about the time of birth. Because of this tears can not drain away from the eye normally. Bacteria can then multiply in the stagnant tears in the tear duct resulting in a discharge that comes back out onto the surface of the eye. 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 eye drops are discontinued.
When should NLDO be evaluated?
It's essential for your pediatrician or pediatric ophthalmologist to determine 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. Evaluating the eye sooner is warranted if there is associated redness in the eye, significant skin irritation, or redness or swelling around the eye.
A mild case of NLDO might cause just excessively watery 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 an NLDO to some degree in the first few weeks of life, and most of these blockages will clear quickly. Up to 90% of blockages resolve spontaneously by the time the child is one-year-old. So initial treatment is usually conservative and involves gently wiping away discharge with a warm moist cloth or using antibiotic drops as necessary for significant discharge. Antibiotic eye drops can be used if needed. However, antibiotics only treat the infection and do not fix the “plumbing” problem in the blocked tear duct.
Massaging the child’s tear sac at home can help open up the blockage. Lacrimal sac (tear sac) massage involves forcing pressure down the tear duct to help open the obstruction. Gentle but firm pressure must be placed above the inside corner of the eye then moved in a downwards motion below the inside corner of the eye.
If the child’s symptoms do not improve by 9-12 months of age (or earlier for extreme symptoms), then a pediatric ophthalmologist can open the nasolacrimal duct to clear the obstruction. This can be completed under brief anesthesia. There is typically no pain afterward. Depending on how the nasolacrimal duct feels as it is being treated, your pediatric ophthalmologist may place a stent in the tear duct to keep it open as it heals for a few months to keep the duct open. Usually, this is easily removed in the office weeks to months later.
These procedures are safe, quick, and successful over 90% of the time.