Blocked Tear Duct in Children - Symptoms, Diagnosis, and Treatment

Pediatric Ophthalmology Basics - Blocked Nasolacrimal Duct

baby with tears as seen with blocked tear ducts
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What are the symptoms of a blocked tear duct and how is it treated?

Blocked Tear Duct (Nasolacrimal Duct) in Children

Newborns and younger infants commonly have some matting in their eyes and may have a lot of tearing. Although often blamed on pink eye, watering eyes without symptoms such as a red eye are more commonly caused by a blocked tear duct, something referred to as dacryostenosis.

A blocked tear duct occurs when the nasolacrimal duct which drains tears from the eye into the nose, gets blocked (because of infection, trauma, etc.) or, more commonly, is blocked from birth (congenital nasolacrimal duct obstruction.

  The most common cause of nasolacrimal duct obstruction in newborns in failure of the membrane guarding the duct - something called the valve of Hasner - to open.

It is estimated that up to 30 percent of newborns are born with a blocked tear duct, but in over 90% of these children, the symptoms resolve by their first birthday.

Symptoms of a Blocked Tear Duct

Infants with a blocked tear duct will often:

  • Have teary eyes, so that their eyes always seem extra moist or simply seem to produce a lot of tears (epiphora) that drain onto the child's cheeks.
  • Have eyes that appear crusted and matted with discharge, because mucoid material that is normally produced in the lacrimal sac backs up onto the eye, instead of draining through the nasolacrimal duct to the nose
  • Have some redness around their eyes because these children often rub their eyes

Occasionally, when a tear duct is blocked, the nasolacrimal sac, which is located between the inner corner of your child's eye and his nose, will become infected.

This condition, called dacryocystitis, can cause the area to become swollen, red, and painful, and your child may also have fever. Most children with a simple blocked tear duct do not have any other symptoms.

Diagnosis of a Blocked Tear Duct

Children are usually diagnosed with a blocked tear duct based on the pattern of symptoms, including the excessive tearing and matting.

Keep in mind that many newborns don't start making tears until they are about two weeks old or a little older, so you may not notice any symptoms of a blocked tear duct, even if your baby is born with it.

Occasionally, a modified fluorescein dye disappearance test may be done, in which a fluorescein dye is placed on a child's eye. After 5 minutes, a special light ("black light") is used to see if all of the dye has disappeared through the tear ducts and into the nose. If not, and the dye remains in the child's eye, then he likely has a blocked tear duct.

Treatments for Blocked Tear Ducts

Fortunately, most cases of blocked tear ducts go away on their own.

Until your child's blocked tear duct does go away, treatments can include:

  • Nasolacrimal massage, in which you massage the inside corner of your child's nose 2 to 3 times a day.  Studies suggest that this massage (which your pediatrician can demonstrate for you) indeed makes a difference, and may reduce the need for nasolacrimal duct probing.
  • Cleaning any discharge or matter in the eyes with a warm washcloth.
  • Antibiotic eye drops when the the discharge in the eyes becomes excessive, like if you are having to wipe it away more than 2 or 3 times a day.
  • Oral antibiotics if your child develops symptoms of dacryocystitis.

If your child's blocked tear duct does not go away on its own, especially by the time he is 9 to 12 months old, additional treatment by nasolacrimal duct probing may be necessary. In this procedure, which is usually very successful, a pediatric ophthalmologist (eye doctor for children) will insert a probe into the nasolacrimal duct, attempting to clear anything that is blocking the duct. Occasionally, a canalicular stent, a silicone tube, is placed into the nasolacrimal duct if it continues to get obstructed.

What You Need To Know

  • Although children with a complete blockage will always have symptoms, if your child has a partial blockage, you may only notice the symptoms when he is making extra tears or if his nose is blocked, like when he has a cold.
     
  • If your younger child is repeatedly diagnosed with pink eye, especially if his eye is not usually red, then he may have a blocked tear duct.
     
  • Children can have a blocked tear duct affecting either one or both eyes.
     
  • If your child's eye are tearing and he is fussy and irritable, instead of a blocked tear duct, your child may be evaluated for congenital glaucomaCongenital glaucoma is uncommon (1 in 10,000 births) and often occurs in the first 2 years of life.  Along with tearing a child may also have a cloudy, dull appearing cornea.  It is important that this disorder be diagnosed, as treatment can preserve vision most of the time when accurately diagnosed.
     
  • If probing is done early, before a child is 6 to 8 months old, it can often be done by a pediatric ophthalmologist in their office, without general anesthesia, like would be necessary for older children.
     
  • A pediatric ophthalmologist can be helpful when your child has a blocked tear duct, although your pediatrician can likely manage most simple cases.

Sources:

American Association for Pediatric Opthalmology and Strabismus. Glaucoma for Children. Updated 04/14. http://www.aapos.org/terms/conditions/55

American Association for Pediatric Opthalmology and Strabismus. Nasolacrimal duct obstruction. Updated 01/16. http://www.aapos.org/terms/conditions/72

Karti, O., Karahan, E., Acan, D., and T. Kusbeci. The natural process of congenital nasolacrimal duct obstruction and effect of lacrimal sac massage. International Pediatrics. 2016 Mar 7. (Epub ahead of print)

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