Tears are responsible for keeping the eyes lubricated and free from debris. They are produced in the lacrimal gland, cross over the cornea, flow through the space between the eyeball and the lids, and finally leave the eye by the nasolacrimal duct, also known as the tear duct. When the tear duct becomes blocked the eye can’t drain normally; causing the eye to become watery, irritated, with eyelash matting and sometimes becoming infected.

The main cause of blocked tear ducts in newborns and infants is the failure of the tear duct to fully open at birth. Obstruction of the nasolacrimal duct affects approximately 10% of newborns, with one-third being bilateral. The condition usually does not require treatment, unless the eye becomes infected. Pediatricians will typically just provide parents with advice on home treatment methods to keep affected eyes clean and healthy while the ducts open naturally. Some pediatricians may recommend massage two to four times a day. Although not required, it may be helpful. If the eye becomes infected, antibiotic eyedrops or ointment will be prescribed and the infection will usually clear within a few days.

By six months of age half of the cases open spontaneously and over 90% resolve completely by 12 months of age. If tear ducts fail to open spontaneously, a procedure known as “probing” may be recommended. This procedure is performed by a pediatric ophthalmologist and has shown to have a 90% success rate. Even though highly successful, the procedure is not normally considered by doctors unless the tear duct remains blocked beyond the child’s first year, or begins to cause discomfort or pain. Signs of bluing, bulging, or persistent infection around the area of the eye are symptoms that could lead a pediatrician to recommend probing of the tear duct.

Probing of the tear duct is a simple but delicate procedure. It involves a probe being passed through the affected duct to clear the blockage. The procedure is performed under general anesthesia to keep the child still and calm. If follow up visits reveal that the tear duct remains blocked, a second procedure may be recommended. Repeated attempts to probe the same duct can create scarring, leading to further tear duct blockage.

In the rare event that tear ducts remain blocked, parents need not worry too much. Blocked tear ducts don’t typically have any adverse affect on quality of life or a child’s vision and several treatment options exist for adults.

Dr. Gina Rosenfeld is a San Diego Pediatrician who has been in practice for 35 years. He is also a member of Children’s Physicians Medical Group.

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