Information about Nasolacrimal Duct Obstruction (blocked tear ducts)

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Your baby may have a sticky discharge in the inner corner of their eye, stickiness of the lids in the mornings, tear-filled eyes that may stream or run down their cheek or in extreme cases a small red swelling in the inner corner of their eye.

Yes. In a partial blockage the eyes may well-up with tears but eventually clear. However, if it is a complete blockage the tears flow down the cheek most times.

Partial blockages, generally resolve over time but a cold or upper respiratory infections (e.g. chest infection) may make the symptoms worse.

Most children grow out of the symptoms as they get older and the following non- surgical practice helps to settle the symptoms.

Non-surgical management:

• Regular cleaning of the lids with a clean wet cotton towel or cotton pads each morning, or if necessary, before bed time, depending on the amount of stickiness present. You should use a different cleaning pads for each eyes and clean the eyes from the inner to outer corner.
  
  
• Lacrimal sac massage: This is the most beneficial non-surgical procedure that can help the symptoms. You place gentle pressure over the inner corner of the eye against the nose (the lacrimal sac), then run your fingers downwards along the length of the bony part of the nose. You should try to do this massage at least one to two times per day, preferably at bath time as the water provides enough moisture for the massage or when feeding as your child is more relaxed. There is no harm trying both sides, as most parents find both side massage easier to perform than just over one eye. Natural green mucus may come out of the eye when massaging. You can use a wet cotton towel or cotton pad to clear this.

• There is usually no need for antibiotic eye drops, unless the white of the eye turns red which is a sign of an eye infection from the blocked tear duct.

• With regular massage, in course of time, you may see the amount of mucus and stickiness gradually decreasing. This can be monitored by maintaining a symptom diary and marking the days when active mucus or stickiness is present. 

• If there is no improvement with regular sac massage, surgical intervention may be discussed.

Surgical Intervention:

We may consider surgical intervention if the symptoms of watering remain bothersome and continue beyond 24 to 30 months of age. These procedures requires children to be put to sleep by means of general anaesthetic.

Here is a brief outline of the surgical procedures that are in practice.

• Probing of naso lacrimal: This procedure involved passing a thin blunt metal probe into the tear duct to open it up. The success or failure of this procedure depends on the extent of the blockage. We can clear small thin membrane like blockages during this procedure, however a complete blockage or tight narrowing of the duct will require a different procedure.
  
  
• Dacryocystorhinostomy (DCR) with or without tubes: this is a procedure where we create a new channel to connect the lacrimal sac to the nasal cavity to by-pass the blockage. This surgery can be done by Ophthalmology team through the skin side or The Ear Nose and Throat (ENT) specialist team through the nasal cavity. We may have to place stents (small hollow tubes) to hold open the new route as it heals. If tubes are placed, your child will need another procedure to remove them.

If your child needs surgery we will discuss this in more detail with you at the clinic appointment.