Blocked Tear Duct

Dear Lisa,

I brought my infant to the doctor’s office because his eye was tearing a lot. The Doctor said that my son has a blocked tear duct. How did he get a blocked tear duct and why does this make him tear so much? I was told to massage the corner of his eye, but every time I try to do this my baby fusses. Any suggestions?

“Baby has a Blocked Tear Duct”

Dear “Baby has a Blocked Tear Duct”,

Each of your baby’s eyes has a lacrimal gland. The purpose of the lacrimal gland is to make tears. The tears serve to clean the eyes; washing away any accumulated dead skin cells, dust or oil from the skin that accumulates. Besides cleaning the eyes, the tears keep the eyeball moist and lubricated. Tears are formed and released onto the surface of the eyes and after cleaning the area the tears pass through the tear ducts and drain into the nose. (1) The process of producing tears and draining the fluid into the nose occurs continuously throughout the day. The tears should be removed as quickly as they are produced.

Many times, an infant’s lacrimal apparatus is immature and not able to clear the tears as quickly as they are produced. It is common for an infant to be born with “Dacrostenosis” or a narrow tear duct. (2) Because the tear duct is narrow it is not able to drain the tears efficiently and it frequently becomes blocked. As a result, an excessive amount of tears can be found rolling down the infant’s cheeks. This condition is commonly referred to as a blocked tear duct.
A baby with a “blocked tear duct” should not have a fever, there should be no swelling around the eye and the white part of the eyeball should not be red. If your baby has any of these signs your doctor should be contacted because it may represent another condition.

The treatment for a blocked tear duct includes gentle massaging of the area with a finger or thumb covered with a soft baby washcloth. The motion should be a slow, steady downward rolling of the finger. (2) The pressure of this motion should cause the tear duct to open. (3) It is important to make sure your fingernails are cut short and smooth so that you won’t scratch the baby’s eye by accident. (3) It is recommended that you massage the area between the bridge of the nose and the corner of the eye where the upper and lower lid meets four times per day. If your baby is fussy, try massaging the area when he is eating because babies tend to be calmer at this time. (3) Another alternative would be to massage the area when your child is sleeping. If the baby continues to fuss when you massage the tear duct I would be concerned that he may have a cyst or an infection of the lacrimal gland. If your baby seems uncomfortable, the area is red or swollen, he has a fever or if the baby continues to be fussy he should be evaluated by his Doctor.

Blocked tear ducts should resolve by the time a baby is between 6 to 9 months old. If the symptoms continue beyond this point you can consult a Pediatric Ophthalmologist who can probe the duct and repair it if necessary. (4) In the meantime, simply wash away the tears and mucus that is produced by cleaning from the inner canthus to the outer canthus of the eye with a soft clean cloth. Many parents become concerned about the amount of mucus and worry that their child may have conjunctivitis. When the tears wash across the eye, they pick up dead skin cells and dirt. Because the tear duct is blocked the fluid is not drained away and instead it continues to accumulate debris, therefore it is not surprising that a lot of discharge results. As long as the eyes are white and not pink the child does not have conjunctivitis and should not need an antibiotic. (3) The administration of antibiotic eye drops will not open an obstructed tear duct. If you cannot tell if the white part of the eye is red or if you are concerned about your baby, you should bring him to the Pediatrician’s office in order to confirm the diagnosis.

(1) Tortora G, Anagnostakos N. Principles of Anatomy and Physiology. 4th ed. Sao Paulo, Sidney:Biological Sciences Textbooks, Inc. 1984:377-379.
(2) Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:126.
(3)Brunell P. Bacterial Conjunctivitis in Children: Containing the Infection. Infectious Disease in Children. 2006:January(S6-7).
(4)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 650.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Parents with Infants