MENUBEFORE & AFTERPATIENT REVIEWSMENUBEFORE & AFTERPATIENT REVIEWSIn babies, the tear duct system that drains tears into the nose may be blocked at birth, or it can become obstructed later for various reasons. Tear duct blockage in babies usually affects one eye, though it can sometimes occur in both.
This condition is quite common in newborns. The most frequent cause is a small membrane or valve at the end of the tear duct that should normally open during or shortly after birth. In some infants, this membrane remains sealed, partially opens very late, or does not open at all without intervention. In rare cases, the blockage may be caused by nasal cysts or tumors, an underdeveloped bony canal, or the accumulation of amniotic fluid trapped within the tear sac.
The most common cause of tear duct blockage in babies is the failure of the valve at the lower end of the duct to open properly. Normally, this one-way valve opens during birth due to pressure changes, allowing tears to drain into the nose. When this valve remains sealed by thin tissue or adhesions, the tear flow is blocked, leading to persistent tearing. In rare instances, the bony canal of the duct may not develop at all.
A condition called amniotocele (or dacryocystocele) may also occur when amniotic fluid becomes trapped in the tear sac, causing it to swell and form a noticeable cyst. This can lead to serious infections or even breathing difficulties in newborns during the first month of life.
Later-onset tear duct obstructions can result from infections, trauma, nasal diseases, or growths that develop inside or around the duct system, exerting external pressure and blocking tear drainage.
Swelling of the left lacrimal sac with amniotic fluid in a newborn: dacryocystocele / amniotocele.
In cases of tear duct blockage in babies, continuous tearing is usually observed, often accompanied by discharge or crusting around the eyes. Depending on the severity of the infection, redness of the eyes, swelling of the eyelids, and irritation of the eyelid skin may occur.
When the tear sac becomes filled with bacteria and infectious debris, a red, firm, and painful swelling may appear between the eye and the nose. This condition, known as dacryocystitis, requires urgent treatment with intravenous antibiotics. After the infection subsides, surgical intervention may be necessary.
Excessive tearing and discharge in the right eye due to congenital tear duct blockage, accompanied by redness of the eyelids.
Dacryocystitis: Inflammation of the tear sac.
When a baby is diagnosed with a tear duct blockage, an ophthalmologist will perform a detailed eye examination to assess all ocular findings.
The treatment of this condition varies depending on the child’s age. Since tear duct blockages resolve spontaneously in about 80–90% of infants by 12–18 months of age, early surgical intervention is generally not recommended.
During the first year, the main treatment methods include massaging the tear sac, maintaining eyelid hygiene by properly cleaning discharge, and using antibiotic eye drops when infection is present or severe.
If the blockage does not show improvement, a surgical procedure is planned when the baby is around 18 months old. In cases where infections are severe or persistent, surgery may be performed earlier.
Surgical options include, in order of preference:
Tear duct massage is one of the most frequently asked about—and often incorrectly performed—methods by parents. The purpose of the massage is to increase pressure inside the tear sac, which is filled with mucus, in order to open the blockage at the lower end of the duct.
It is incorrect to perform the massage by gently rubbing the nose. The correct technique involves placing the tip of the little finger in the hollow area between the eye and the nose, then applying downward pumping motions toward the deeper tissue. When performed correctly, you may see discharge or pus flowing from the eye, indicating that the sac is being emptied. Your oculoplastic surgeon will demonstrate the proper massage technique during the examination.
Tear duct blockage cannot be treated solely with eye drops. Antibiotic drops are used to treat infections or inflammation that occur as a result of the blockage, but long-term use should be avoided due to potential side effects. These drops should only be used under a doctor’s supervision and for short durations.
In most cases (80–90% of infants),tear duct blockage resolves spontaneously or with the help of proper massage by the age of 1 to 1.5 years.
If symptoms such as tearing and discharge gradually decrease over time, the likelihood of spontaneous recovery is very high. In such cases, close monitoring and medical management—without immediate surgery—are considered the healthiest and safest approach.
The most commonly preferred surgical method for babies between 18 and 24 months of age is the probing technique. The reported success rate for this procedure in a single session is approximately 90–98%.
For babies who are seen at a later stage or whose initial probing was unsuccessful, a tube (stent) placement into the tear duct system is performed in addition to probing. When done at the appropriate time, the success rate for this technique is reported to be 95–100%.
In cases where the condition is addressed at a much later age (from around 5 years old) or when previous probing or intubation procedures have failed, an adult-type tear duct surgery (Dacryocystorhinostomy – DSR) is performed.
Probing procedure performed through the right upper tear duct system.
In the treatment of tear duct blockage in babies, the probing procedure is highly successful when performed at the right time and by experienced hands. The generally accepted medical approach is to wait until around 12–18 months of age, as the blockage may resolve spontaneously during this period. However, after this age, the success rate of probing decreases with time, so if the symptoms persist, it is important not to delay the procedure further.
A simple probing procedure is performed under general anesthesia and typically takes about 10–15 minutes, including nasal manipulation. It is preferable for the procedure to be done under endoscopic control to confirm that the probe exits through the correct passage.
In intubation surgeries, probing is first performed, and then a tube (stent) is placed into the expanded duct. Depending on the type of tube used, this may add an additional 2–10 minutes to the total surgical time.
Probing (or lacrimal duct probing) is performed using fine metal probes that advance through the natural tear duct system without any external incision. For an experienced surgeon, it is a short, safe, and straightforward procedure. However, if performed improperly, it may damage the mucosal lining of the duct, create false passages, or lead to permanent obstruction of the system.
After surgery, babies usually wake up from anesthesia without pain or discomfort and quickly return to their normal routines. No special care or precautions are typically required. Depending on the procedure, mild swelling or slight blood-tinged nasal discharge may occur for 1–2 days. Since there are no external incisions in probing or intubation procedures, no scars or wound healing issues occur.
Your doctor may prescribe antibiotic and possibly steroid eye drops, as well as nasal sprays. Ointments are generally not preferred in these cases.
The diagnosis and treatment of tear duct blockage in babies are among the core areas of oculoplastic surgery. These procedures are typically performed by ophthalmologists or oculoplastic surgeons who have specific experience and expertise in pediatric eye surgery.
Altuğ Çetinkaya, MD, FEBOOphthalmologist Turkey
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