Blocked tear ducts

The Pediatric Insider

© 2011 Roy Benaroch, MD

Belinda can’t make sense out of what she’s been told by her baby’s pediatrician, who told her that a blocked tear duct is to blame for watery, gunky eyes. “If the tear duct is blocked, shouldn’t my baby have dry eyes? They’re always watery, and sometimes they get gunky. The pediatrician has prescribed eye drops and told me to massage her eyes. What should I do?”

Blocked tear ducts in little babies are very common, and usually will fix themselves without any intervention at all. I don’t think eye drops are likely to help, nor will massaging anything—especially not massaging the eyes themselves. The best thing for Belinda to do is to leave those baby eyes alone.

This will make somewhat more sense with a drawing (thanks to http://health.allrefer.com/pictures-images/tear-duct-blockage.html):

Tears are made in the lacrimal glands, which are tucked above your eyes, under your eyebrows. They flow from there down into the eye through little tiny ducts in the upper lid. These “going in” ducts are not the ducts that get blocked in babies.

From there, tears swirl around the eyes, then drain out though ducts on the inside area of the lids, near your nose. That’s right: your tears end up in your nose. That’s why you can kind of taste eye drops after you put them in (they flow from eyes into nose, into the back of your throat, where you can taste them.) That’s also why your nose runs when you cry.

It’s those “drainage” ducts that sometimes get blocked in babies. Want to see them? If you look very closely at your own lower lids in a mirror, you can probably spot the opening to the tear drainage ducts just near the edge of the lower lid, near your nose. It’s very small, and looks really more like a dark dot than a duct opening. Go look for yours, I’ll wait here.

Found it? It’s tiny. Yours probably doesn’t have a big red arrow pointing at it, like mine did. In a baby, that little duct is especially small—and sometimes it is blocked by a little debris, or hasn’t even opened up completely when a baby is born.

With a blocked drainage duct, tears just kind of well up in the eyes, making them watery. Sometimes the tears get thick and gunky. Have no fear—that’s not a pink eye or an eye infection. If it were, the white of the eye would be pink or red. If your little baby has watery or gunky eyes but the whites are white, it’s almost certainly a blocked duct. Your pediatrician can confirm the diagnosis with a brief history and exam.

What should you do about it? Some people recommend tear duct massage, rubbing the area under the eye by the nose several times a day. This doesn’t actually work, but gives worried parents something to do. Another idea: you can use antibiotic eye drops, which might make the gunky goo look more watery, but certainly won’t help unclog the duct. In other words, eye drops won’t do much good. If you do use them, stop after a few days. Continuous use of these kinds of eye drops can make the eye sensitive and red, which will confuse everything.

The best thing to do with blocked tear ducts in a baby is to leave them alone. As your baby grows, they’ll usually open up on their own. Rarely, if they don’t open up, an ophthalmologist can perform a minor surgical procedure, usually after six months of life. This will require general anesthesia, so it’s best to wait and see if the blocked ducts improve on their own rather than rush into the operating room. Still, if eyes stay gunky much past six months, it’s time for the ophthalmologist to take a look.

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