Blocked Tear Duct

Tears from the eye normally drain into the nose through the tear duct. If this duct is blocked, the tears spill over on the cheeks, even when a baby is not crying. This happens often in very young babies. Most of the time, only one tear duct is blocked at a time.

Your child may have a blocked tear duct when:

• One eye is always watery. 
• Tears run down the face even when your baby does not cry. 
• When crying, the nostril on the blocked side is still dry. 
• The eye on the blocked side is not red, and the eyelid is not swollen. 
• The problem starts before your child is 1 month old.

Although the blockage was present at birth, your baby may not have symptoms right away. This is because in some babies, tear production is sometimes delayed until 3 or 4 weeks of age. 

This is a common condition, affecting 6% of newborns. Both sides are blocked 30% of the time. Over 90% of blocked tear ducts open up without treatment by the time a child is 1 year old. If the blockage continues after age 1 year, an ophthalmologist (eye specialist) can open it with a probe. 

Massaging the lacrimal sac (where tears collect) is not required. The lacrimal sac is in the inner, lower corner of the eye. The tear duct will open without any massage. If massage is recommended by your healthcare provider, do the following:

• Massage the lacrimal sac upward twice a day to empty it of old fluids and prevent infection. 
• Start at the inner corner of the eye and gently press upward, using a cotton swab. A small amount of clear fluid should come out. Always wash your hands carefully before doing this. Your provider can teach you the correct technique.

The massage technique is somewhat controversial. Some providers recommend massaging downward instead of upward in hopes of washing out the plug that blocks the lower duct. Some providers recommend not massaging the sac at all. Massage in either direction must be done gently, since it may irritate the eyelid tissue and contribute to infection.

Because of poor drainage, eyes with blocked tear ducts become easily infected. The infected eye produces a yellow discharge. If the eye becomes infected, it is very important to begin antibiotic eyedrops and to stop the massage.

• The eyelid becomes very red or swollen. 
• A red lump appears at the inner lower corner of the eyelid.

• Lots of yellow discharge occurs. 
• The eye is still watering after your child is 1 year old. 
• You have other concerns or questions.

Written by B.D. Schmitt, MD, author of "Your Child's Health," Bantam Books.
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.