Blocked Tear Ducts in Infants (CNLDO)
A blocked tear duct, or congenital nasolacrimal duct obstruction (CNLDO), is a fairly common and usually temporary problem in infants. It occurs when the nasolacrimal duct—the tiny channel that lets tears drain from the eye into the nasal cavity—remains blocked or closed off at birth.
CNLDO occurs in approximately 5% of newborn infants. The blockage is located most commonly at the distal end of the duct, near the opening in the nose. The blockage can affect one or both eyes, and does not run in families. Crucially, the rate of spontaneous resolution is estimated to be 90% within the first year of life.
What are the Symptoms of Blocked Tear Ducts?
The symptoms of a blocked tear duct usually appear in the first few weeks of life and include:
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Constant Watering (Epiphora): The eye looks wet, or tears pool and spill over onto the cheek even when the baby is happy and not crying.
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Sticky Discharge: A white or yellowish mucus-like substance collects on the eyelashes and corners of the eyelid, often crusting during sleep.
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Chapped Eyelid Skin: The skin surrounding the eyes can become red and irritated due to constant wetness from tearing.
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Reflux of Mucus: Gently pressing over the inner corner of the eye (near the nose) can cause a small amount of mucus to well up into the eye.
Treatment Options for Blocked Tear Ducts
Because the vast majority of cases open on their own by age 9 to 12 months, our pediatric eye specialist recommends a conservative initial approach:
- Lacrimal Sac Massage (Crigler Massage): Applying gentle, downward pressure over the inner corner of the eyelid. This increases pressure inside the duct system, helping pop open the thin membrane at the bottom of the nose. Our specialist will demonstrate the correct technique to parents.
- Antibiotic Eye Drops: Prescribed only if there is a significant amount of sticky, yellow-green discharge, which indicates a mild localized infection in the tear sac.
- Tear Duct Probing: If the duct remains blocked after the baby is 10 to 12 months old, a quick, safe outpatient procedure called probing is recommended. A microscopic metal probe is gently passed through the drainage channel to open the thin membrane. It is performed under brief general anesthesia for the child's safety and comfort, and resolves more than 90% of cases.
- Advanced Options (DCR or Intubation): In rare cases where probing fails, placement of a thin silicone tube (intubation) to keep the channel open, or a micro-bypass surgery (dacryocystorhinostomy - DCR) may be considered when the child is older.
At Utsav Eye Clinic, Kharghar, we specialize in the comprehensive diagnosis and care of pediatric lacrimal conditions. For more details on tear duct probing, you can read our dedicated Tear Duct Treatment & Surgery Guide.