Tear duct blockage in infants

Dacryostenosis¹, more commonly known as a blocked tear duct, happens when there is obstruction in the nasolacrimal duct. This usually happens when the tear duct is narrow or when the lower end or top of the duct does not open up as it should at birth which causes blockage^2,3. Even though this obstruction may be congenital (already present at birth), it may not be obvious to parents as tear production only starts developing in newborn babies around 2 weeks onwards¹.

Signs and Symptoms

Under normal circumstances, tears produced in the lacrimal gland will drain through the nasolacrimal duct to the nose. However, when there is a blockage, tears will not drain properly and remain in the corner of the eye.

Typically, a month-old baby that is experiencing tear duct blockage may always be seen with watery eye(s) or epiphora. There may be constant tearing even though the baby does not seem to be crying.

The build-up of tears may also cause the infant to wake up with sticky discharge or crusty matters in the eye(s)⁶. For older babies, you may probably notice slight redness around the eyes from the constant rubbing of the eyes.

Complications

When the child experiences more severe symptoms such as swelling, tenderness and redness inside or around the eye and nose; recurrent eye infections, it could even manifest as conjunctivitis or dacryocystitis², an infection due to trapped bacteria in the nasolacrimal sac. Other rarer causes can be craniofacial deformity, tumour, etc. These conditions will require prompt medical treatment.

Treatment

In general, most nasolacrimal duct obstruction will resolve without any treatment as the baby gets older around 12 months of age^3,4,5. However, if symptoms are persistent with no improvement, doctors may start with conservative therapy by massaging in between the nose and inner corner of the eye daily, to assist in removing the blockage in the tear duct.

When there is no progress, the doctor may then proceed with a more invasive treatment. Some procedures carried out by ophthalmologist to alleviate the condition includes surgical probing^2,3 where the membrane that obstructs the tear duct is being removed or by using a balloon catheter^2,3 to widen the ducts.

One key thing to note is to always wipe your baby’s eyes/eyelids with a clean towel daily to maintain proper hygiene. In addition, schedule your baby for a consultation at the paediatric optometrist or ophthalmologist when in doubt for an early diagnosis.

References:

1. Garrity J. Dacryostenosis. MSD Manual Professional Version website. May 2019. https://www.msdmanuals.com/en-sg/professional/eye-disorders/eyelid-and-lacrimal-disorders/dacryostenosis
2. What is a blocked tear duct? American Academy of Ophthalmology website. https://www.aao.org/eye-health/diseases/what-is-blocked-tear-duct
3. Stephens C. What causes a blocked tear duct in infants? Medical News Today. July 17, 2018. https://www.medicalnewstoday.com/articles/322486
4. Gill K R. At-Home Treatments for Blocked Tear Ducts in Babies. Healthline website. December 6, 2018. https://www.healthline.com/health/parenting/baby-blocked-tear-duct
5. Blocked tear duct. Mayo Clinic website. https://www.mayoclinic.org/diseases-conditions/blocked-tear-duct/symptoms-causes/syc-20351369
6. Blocked tear duct. Raisingchildren.net.au website. https://raisingchildren.net.au/guides/a-z-health-reference/blocked-tear-duct