What causes a blocked tear duct in infants?
The American Academy of Ophthalmology report that as many as 20 percent of babies are born with a blocked tear duct, which is also called a nasolacrimal obstruction.
Tears come from tear glands, which sit above a person's eyes on the side furthest from the nose. The tears drain through the tear ducts into the nose. Blockages can develop in the tear ducts and prevent tears from draining normally.
Tears play a significant role in people's vision. They help to maintain the health of the eyes by keeping them moist and supplying them with oxygen. They also protect the eyes by coating their surface with natural antibiotics and washing away irritating or harmful substances.
Symptoms of a blocked tear duct in a baby
Blocked tear ducts normally improve without treatment.
According to leading ophthalmologists, blocked tear ducts are the most common disorder of the tear duct system in infants.
Infants with this condition will typically display the following signs:
- tearing, which is worse in chilly or windy conditions or if the infant has a cold
- excessive watering of the eyes, or epiphora
- discharge from the eyes, also known as mattering or rheum, which can be either watery or a combination of mucus and pus, depending on the location of the blockage
- pressure on the inner corners of the lower eyelids may increase the discharge
- blocked tear ducts affect both eyes about 30 percent of the time
These signs may begin to show by the time a baby is 3 weeks old.
Even though their eyes may be full of tears, a blocked tear duct does not usually cause a baby much discomfort. If a baby with tearing and eye discharge seems to be uncomfortable, it is best to take them to see a doctor.
What are the causes?
The most common cause of a blocked tear duct in a baby is a tear duct system that has only partially developed.
This can lead to the following issues:
- the valve at the end of the tear duct does not open correctly
- the openings in the eyelids (punta) that tears usually flow through have not developed properly
- the tear ducts are too narrow
Less common causes
The following causes of a blocked tear duct in a baby are less common:
- infections causing swelling in the face, which puts too much pressure on the tear ducts
- the nasal bone blocking the path that tears would typically follow into the nose
- nasal polyps
- cysts or tumors
- injury to the tear ducts
The American Optometric Association recommend a full eye examination at 6 months.
The symptoms of a blocked tear duct in a baby begin developing early and will typically always be present before the baby is 3 months old.
Doctors look for the following signs to make a diagnosis:
- excessive tearing
- a swollen pool of tears below the eyes, known as a lacrimal lake
- discharge from the eyes
- crusty eyes or eyelashes after sleeping
- a bump near the corner of the eye
- swelling, soreness, or tenderness near the nose
A doctor will thoroughly examine the baby to ensure that other conditions are not responsible for the symptoms.
The majority of blocked tear ducts resolve without treatment within the first year of the baby's life.
As a result, doctors tend to recommend conservative treatment only, while carefully monitoring the infant's health. This should clear 90 percent of tear duct blockages.
Conservative treatment methods
Some doctors may suggest massaging the tear sac. This forces fluid through the tear ducts which can remove the blockages.
They may also prescribe antibiotic eye drops if the baby's eyes are producing a lot of discharge, but this will not fix the underlying problem.
More invasive treatment methods
In some cases, a tear duct will not unblock with time and conservative treatment, and the doctor will need to use a different treatment method.
The most common approach is surgical probing, where the doctor inserts a medical instrument into the tear duct to remove the obstruction. For infants aged 6 months or younger, surgical probing will generally take place in the doctor's office without anesthesia. Slightly older children are more likely to undergo the procedure in an operating room under general anesthesia.
If probing does not entirely resolve the problem, additional treatment options may include:
- using stents to keep the ducts open
- using a balloon catheter to widen the ducts
- altering the structure of the nasal cavity to promote drainage
- using nasal endoscopy to remove cysts from the tear duct
- using surgery to establish a new opening into the nasal cavity, although this is more common in adults
It can take up to 7 days after any of these procedures for the baby's symptoms to begin to improve.
Use a cotton ball soaked in water to clean crust from the eye.
Soak a soft cloth or cotton ball in warm water and use it gently to clean the crusty matter and dried discharge from the baby's eyes.
This is particularly important to do before using prescription antibiotic eye drops.
Always wipe the infant's eye from the inside, near the nose, toward the outside. Use a fresh cotton ball or a different part of the cloth for each eye if necessary.
Massage is the home treatment that doctors most commonly recommend for a blocked tear duct. An ophthalmologist or doctor can show people how to use this procedure on themselves or their child to open up the tear duct.
The American Academy of Ophthalmology suggest massaging the ducts using 10 strokes twice a day. For a baby, it is best to do the blocked tear duct massage during a diaper change.
Experts frequently recommend using a cotton swab rather than a finger, because the swab's smaller size makes it easier to target the tear sac.
People can place hot compresses, such as a warm, moist washcloth, gently over the eyes to help relieve the symptoms of a blocked tear duct.
When to see a doctor
The American Optometric Association recommends a full eye examination for all infants at 6 months, even if no problems are evident. If there are concerns about the health of a baby's eyes, it is advisable to see a doctor right away.
Prompt treatment of an infant with a blocked tear duct, even conservative treatment, can reduce the risk of infection and the need for more invasive procedures at a later date.
Blocked tear ducts in babies generally resolve themselves.
It is essential to see a doctor if an infant has very watery eyes, discharge, or appears to be tearing an unusual amount without any apparent cause. In addition, as a blocked tear duct in a baby will not typically cause a child pain, it is advisable to seek medical advice if the baby is showing signs of discomfort or is unusually sensitive to light.