When an obstruction occurs in the duct system which carries tears away from the surface of the eye to the nose, it is called a blocked tear duct or nasolacrimal duct obstruction.
Tears are produced in the lacrimal gland located above the lateral aspect of the eye. These tears are secreted and travel across the cornea, exiting via the superior and inferior puncta (holes) on the inner (medial) corner of the eye. Usually, a small tube called the nasolacriminal duct drains the tears from the surface of the eye into the nose. This duct is usually developed by birth but up to 1% to 5% of the population may have a duct that is incompletely developed or obstructed. The nasolacrimal duct has three valves in it and the majority of nasolacrimal duct obstructions occur at the most distal valve that is located in the nose (Hasner's Valve).
Babies begin to produce tears at two days to two weeks after birth. You may notice excessive tearing from one or both of your infants' eyes during this time. Rarely, adults get a blocked tear duct because of an infection, an injury, or a tumor.
The main symptom of a blocked tear duct is increased or excessive tearing.
A blocked tear duct is diagnosed after a standard eye exam or an internal examination of the nose. If necessary, the drainage of the tears can be tracked by an eye stain.
Nearly half of the cases of nasolacrimal duct obstruction will resolve spontaneously by 6 months of age. A pediatric ophthalmologist may need to probe your childs eye between 6 to 12 months of age to help open up the obstruction. In rare circumstances, the probing does not fix the problem completely and a silicone stint may have to be placed in the nasolacrimal duct for 1 to 3 months to help keep the duct open.
In the meantime, your health care provider may choose to prescribe antibiotic drops or ointment if your child has persistent yellow drainage from the eye. Some health care providers recommend a massage technique to try to unblock the duct. Two methods have been recommended. You may place a washed finger between the nose and the inner corner of the eye. Massage downward (inferiorly) in an attempt to push the tears through the nasolacrimal duct via its normal path. Another recommendation calls for a superior motion in the same location, pushing the tears out of the duct. You should do this procedure at every other feeding for a newborn.
A blocked tear duct can cause a significantly higher amount of eye infections resulting in yellow discharge from the eye. These infections can be treated by antibiotic eye drops or ointment.
Rarely, your child may develop a bluish swelling on the skin between the nose and the inner corner of the eye(an amniotecele). Massage may be attempted. However, if the swollen area becomes red and inflamed, you should contact your health care provider immediately for an abscess may be developing which requires IV antibiotics and probing.
Nelson LB, Calhoun LJ, Menduke H. Medical Management of congenital nasolacrimal duct obstruction. Pediatrics 76: 173 1985
Wright, KW. Pediatric Ophthalmology for Primary Care, 2003, American Academy of Pediatrics
Reviewed by: Evan Taragano MD
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