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Blocked Tear Duct

Pediatric Ophthalmology Basics

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Updated May 01, 2007

Newborns and younger infants commonly have some matting in their eyes and may have a lot of tearing. Although often blamed on pink eye, without any other symptoms, such as a red eye, it is more commonly caused by a blocked tear duct or dacryostenosis.

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). It is estimated that up to 30 percent of newborns are born with a blocked tear duct.

Symptoms of a Blocked Tear Duct

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
Occasionally, when a tear duct is blocked, the nasolacrimal sac, which is located between the inner corner of your child's eye and his nose, will become infected. This condition, called dacryocystitis, can cause the area to become swollen, red, and painful, and your child may also have fever. Most children with a simple blocked tear duct do not have other symptoms though.

Diagnosis of a Blocked Tear Duct

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

Occasionally, a modified fluorescein dye disappearance test may be done, in which a fluorescein dye is placed on a child's eye. After 5 minutes, a special light is used to see if all of the dye has disappeared through the tear ducts and into the nose. If not, and the dye remains in the child's eye, then he likely has a blocked tear duct.

Treatments for Blocked Tear Ducts

Fortunately, most cases of blocked tear ducts go away on their own.

Until your child's blocked tear duct does go away, treatments can include:

  • nasolacrimal massage, in which you massage the inside corner of your child's nose 2 to 3 times a day
  • cleaning any discharge or matter in the eyes with a warm washcloth
  • antibiotic eye drops when the the discharge in the eyes becomes excessive, like if you are having to wipe it away more than 2 or 3 times a day
  • oral antibiotics if your child develops symptoms of dacryocystitis
If your child's blocked tear duct does not go away on its own, especially by the time he is 9 to 12 months old, additional treatment by nasolacrimal duct probing may be necessary. In this procedure, a pediatric ophthalmologist will insert a probe into the nasolacrimal duct, attempting to clear anything that is blocking the duct. Occasionally, a canalicular stent, a silicone tube, is placed into the nasolacrimal duct if it continues to get obstructed.

What You Need To Know

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

  • If your younger child is repeatedly diagnosed with pinkeye, especially if his eye is not usually red, then he may have a blocked tear duct.

  • Children can have a blocked tear duct affecting either one or both eyes.

  • If your child's eye are tearing and he is fussy and irritable, instead of a blocked tear duct, your child may be evaluated for congenital glaucoma.

  • 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, like would be necessary for older children.

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



Sources:

Behrman: Nelson Textbook of Pediatrics, 17th ed.

Evaluation and management of congenital nasolacrimal duct obstruction. Kapadia MK - Otolaryngol Clin North Am - 01-OCT-2006; 39(5): 959-77, vii

Acquired nasolacrimal duct obstruction. Mills DM - Otolaryngol Clin North Am - 01-OCT-2006; 39(5): 979-99, vii

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