FAQs

Tearing and Your Baby (Nasolacrimal Duct Obstruction)

Most infants who have a blocked tear duct during the first year of their life will get better without any treatment.
Babies enter the world with a cry
but they do not begin producing tears until about three weeks later. Tears
which are necessary for the natural lubrication of the eyes
flow through a series of drainage channels that carry the fluid into the nose.

Babies who have noticeable watering of the eyes – with tears overflowing from the lids onto the cheeks – probably have a blockage in their tear drainage system. This problem is very common
occurring in about one in three babies. In 6 to 20 per cent of those babies
there are noticeable symptoms. Most cases resolve completely within the first year of life. If not
the blockage can be opened with gentle massage or with a simple treatment.

Symptoms of Blocked Drainage

The eyes may water excessively
even when your baby is not crying
and the eyelashes may have crust and mucous on them
particularly in the morning. If there is an infection
which can result from the abnormal backup and pooling of tears
the eyes may become red and the lids may swell
perhaps with a thick yellowish-white discharge. The symptoms of a blocked tear duct may get worse after a sinus or upper respiratory infection. Also
they may be more noticeable after the baby has been exposed to wind and cold
because these may cause increased production of tears.

What Causes the Tearing?

Tears normally drain from the eyes through tiny tube-like channels called canaliculi
which are located under the skin at the inner corner of the eyelids. These channels carry the tears into the tear sac
near the side of the nose
and then into the tear duct
which empties into the nose (that’s one reason your nose runs when you cry).

In most newborns
there is a thin membrane covering the tear duct where it enters the nose. This membrane usually opens within the first six weeks of life
but in some babies it doesn’t open until much later. In others
the membrane needs some help becoming unblocked.

Treatment

Most infants who have a blocked tear duct during the first year of their life will get better without any treatment. But you can help speed up the process by massaging carefully over the tear sac. If excessive mucous production or eye infections accompany the tearing
antibiotics may also be prescribed.

How to massage: Find the tear sac by placing your index finger firmly on the inner corner of the baby’s eyelids
near the nose. You will feel a ridge of bone under your finger. Press down gently but firmly toward the nostril and hold it (do not rub) for 3 to 4 seconds. Do this three or four times a day
making sure your hands are freshly washed and fingernails are short. If you do not understand these instructions
someone in the office will go over them with you.

What Is a Probing?

If the tearing problem does not improve after allowing sufficient time for the natural opening process and the massaging to work
or if your baby has frequent eye infections
the tear duct may need to be probed. This procedure involves a thin metallic rod being gently slipped into the tear duct and pushed through the membranous block. The probe acts like a pipe cleaner to remove the obstruction.

This is a painless
minor procedure that usually takes less than five minutes. If your baby is older than six months
the procedure will probably be performed in the hospital operating room
since general anesthesia may be needed to keep the baby from moving while the delicate channels near the eyes are being probed.

Except for the time in the operating and recovery rooms
you will be able to stay with your baby
and he or she can go home with you the same day. Occasionally
a baby develops a mild nosebleed after returning home. If bleeding is any more than a few drops
please call the office right away. Probing is about 90 to 95% effective and is an extraordinarily safe procedure. For those few infants in which probing fails
a second probing may be attempted
or silicone tubes may be placed in the tear duct until an open passageway is secured
usually about three to six months after placement.

Prognosis

The majority of obstructions will open spontaneously by the time your baby is one year old. If this is not the case
nasolacrimal duct probing is usually performed. This procedure is generally quite safe
and can often provide an immediate cure. In a very small number of babies
it may not work because of some other abnormality of the tear drainage system. In that case
additional procedures will be required to allow tears to drain properly. If any type of surgical procedure is recommended for your baby the risks present with any surgery and anaesthesia will be carefully explained to you along with the potential benefits. Fortunately tearing problems are almost always managed simply and successfully. Being born with a blocked tear duct does not mean that a baby will have other congenital eye problems.