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Nasolacrimal Duct Disorders

Nasolacrimal Duct Disorders

About 5 percent of babies are born with a blocked tear duct in one or both eyes—a condition known as nasolacrimal duct obstruction. Infants may be born with an undeveloped tear duct, or there may be a thin film on the duct that causes a partial blockage. More than 90 percent of blocked ducts open by themselves before a child turns one.

In healthy eyes, tears drain into small openings called the puncta, located in the corner of the upper and lower eyelids. Tears then flow into the nasolacrimal duct. If this duct is blocked, tears overflow on the cheek.

The most common reason for a blocked tear duct is a membrane at the end of the tear duct that does not open normally. Tear duct obstruction can also be caused by:

  • A missing lower or upper eyelid
  • A duct system that is narrow
  • An infection of a nasal bone that obstructs the duct where it enters the nose

Children with Down syndrome, cleft syndromes and other congenital conditions may be more prone to blocked tear ducts.

Common symptoms include:

  • Increased tearing
  • Tears that overflow onto the eyelashes, eyelids, face or cheek
  • Tears that seem thicker and may become dry and crusty
  • Red eyelids that may stick together and a yellowish-green discharge

An upper respiratory illness, a cold or exposure to wind and cold can affect the severity of the problem. Tear duct blockage can also increase the chance infection. Severe cases may result in a serious infection of the tear duct system called dacryocystitis.

Diagnosis of Nasolacrimal Duct Obstruction

Ophthalmologists at Riley at IU Health can diagnose a blocked tear duct and check for other rare causes of excess tears in infants, such as glaucoma. Diagnostic tests for a blocked tear duct include an eye exam or a special eye stain to see how your child’s tears drain. Occasionally, an x-ray may be taken to examine the tear duct.

Treatments

In many cases, your child’s tear duct will open on its own. We may choose to monitor your child to see if the problem resolves without treatment.

The most common treatment for a blocked tear duct are:

  • Tear duct massage. You can care for a blocked tear duct at home by cleaning the eyelids with a warm, wet washcloth. Gently massaging the area two to three times a day may also help open the tear duct. Ophthalmologists at Riley at IU Health can teach you how to safely rub the area from the inside corner of the eye, toward the nose.
  • Topical antibiotic eye drops. Antibiotic eye drops or ointment may be prescribed to treat discharge around the eye.
  • Tear duct probing. For this procedure, a smooth probe similar to a thin straight wire is gently passed through the tear duct and into the nose. Topical anesthetic drops might be used for the procedure in younger children; older children may need a general anesthetic. We may also place a tube in the nasolacrimal system to prevent a recurrence. Probing is successful 90 percent of the time, but additional procedures may be necessary. In rare cases, a more complex surgery may be needed to resolve the problem.

Key Points to Remember

  • About five percent of babies are born with a blocked tear duct in one or both eyes.
  • Increased tearing is the most common symptom, and parents may notice the increase about two to three weeks after their baby is born.
  • More than 90 percent of blocked ducts will open by themselves before a child turns one.
  • Since many cases resolve by themselves, your ophthalmologist may choose to monitor your child first.
  • If treatment is needed, tear duct massage and antibiotic eye drops are common options.
  • Tear duct probing may be needed if massage is not successful. Probing is successful 90 percent of the time.

Support Services & Resources

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

American Association for Pediatric Ophthalmology and Strabismus

This organization supports improved eye care for children and shares information on eye conditions for patients, families, physicians and other healthcare professionals.

Locations

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.

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