Blocked Tear Ducts

A constantly watery or “goopy” eye is common in babies, and one of the most frequent causes is a blocked tear duct, also called nasolacrimal duct obstruction (NLDO).

Babies with a blocked tear duct may have tears running down the cheek even when they aren’t crying. The eye may frequently collect mucus or yellowish discharge, and the eyelashes can become wet or crusted. Symptoms often improve and then return, especially when a child has a cold or nasal congestion.

Most blocked tear ducts in babies open naturally during the first year of life. When a blockage doesn’t resolve on its own, a pediatric ophthalmologist can determine whether treatment is needed.

At Children’s Eye Care, our pediatric ophthalmologists have extensive experience evaluating and treating blocked tear ducts in infants and children—from reassuring families whose baby’s tear duct is likely to open naturally to performing tear duct procedures when the obstruction persists.

Pediatric Blocked Tear Duct Specialists in Metro Detroit

Children’s Eye Care has specialized in pediatric eye care in Metro Detroit since 1973. Blocked tear ducts are among the common conditions our pediatric ophthalmologists evaluate in babies and young children.

Although a blocked tear duct is usually straightforward, not every watery, crusty or red eye is caused by a blocked tear duct. Pediatric expertise is particularly important when symptoms are unusual, severe, affect the eye itself or don’t follow the expected course.

Our pediatric ophthalmologists can determine whether a child’s symptoms are consistent with a routine congenital blocked tear duct or whether another eye condition should be considered. When treatment is necessary, our physicians also have extensive surgical experience treating persistent nasolacrimal duct obstruction in children.

What Is a Blocked Tear Duct?

Tears don’t simply disappear after lubricating the surface of the eye.

Normally, tears drain through tiny openings near the inner corner of the upper and lower eyelids. From there, they travel through the tear drainage system and eventually into the nose.

That connection explains something you’ve probably noticed yourself: your nose may run when you cry.

In babies with a congenital blocked tear duct, the drainage pathway has usually not completely opened by birth. Most commonly, a thin membrane remains at the lower end of the nasolacrimal duct, preventing tears from draining normally.

When tears can’t drain efficiently, they collect on the eye and may spill onto the cheek. Mucus and bacteria that would normally drain through the system can also accumulate, causing the familiar discharge or crusting parents often notice.

What Does a Blocked Tear Duct Look Like in a Baby?

Symptoms may begin during the first days or weeks of life, once a baby begins producing more tears.

Parents commonly notice:

• Constant or frequent tearing
• Tears running down the cheek when the baby isn’t crying
• Wet eyelashes
• Mucus or yellowish discharge
• Crusting of the eyelashes, particularly after sleeping
• Symptoms that repeatedly improve and return
• Increased tearing or discharge during a cold or nasal congestion
• Symptoms affecting one or both eyes

One clue is that the white part of the eye often remains relatively white despite the tearing and discharge.

That distinction matters because significant redness of the eye itself can suggest something other than a simple blocked tear duct.

Is a Blocked Tear Duct the Same as Pink Eye?

No, and this is a very common source of confusion.

Both a blocked tear duct and conjunctivitis (pink eye) can cause discharge or crusting around a child’s eye.

With a typical blocked tear duct, the primary problem is poor tear drainage. The eye may be watery and produce mucus, but the white part of the eye often isn’t significantly red.

Conjunctivitis involves inflammation of the conjunctiva and commonly causes more noticeable redness of the eye itself.

That doesn’t mean parents should try to diagnose the difference from a photograph or description alone. A red or draining eye can have several causes, and infants in particular deserve appropriate evaluation when symptoms aren’t typical.

Related: Conjunctiva & Eye Surface Conditions

Why Does My Baby’s Blocked Tear Duct Keep Getting “Infected”?

Parents often describe the eye as repeatedly infected because the discharge disappears and then comes back.

Usually, that’s because the underlying drainage problem is still present.

Tears and mucus normally flow through the tear drainage system into the nose. When that pathway is blocked, fluid can remain in the system, allowing mucus and bacteria to accumulate.

The amount of discharge can vary from day to day. It often becomes more noticeable when a child has a cold because swelling and congestion around the nose can make tear drainage even less efficient.

So a suddenly “goopy” eye doesn’t necessarily mean your child has developed a brand-new infection every time.

Do Antibiotic Eye Drops Open a Blocked Tear Duct?

No. Antibiotics do not open the tear duct.

This is an important distinction.

Antibiotic eye drops or ointment may occasionally be prescribed when there is significant discharge or concern for bacterial overgrowth, but medication does not remove the underlying obstruction.

If symptoms return after antibiotic drops are stopped, it doesn’t necessarily mean the antibiotic failed. The tear duct may simply still be blocked.

Routine long-term antibiotic use is generally not the solution for a persistent blocked tear duct.

How Are Blocked Tear Ducts Diagnosed in Babies and Children?

A pediatric ophthalmologist can often diagnose a congenital blocked tear duct based on the child’s history and eye examination.

The examination also allows us to look for other causes of tearing and discharge.

That’s important because tearing is a symptom, not a diagnosis.

Although a blocked tear duct is common, excessive tearing can occasionally be associated with other eye problems. The child’s age, appearance of the eye, presence of redness or light sensitivity, corneal appearance and other examination findings help determine whether the symptoms are consistent with routine nasolacrimal duct obstruction.

Do Blocked Tear Ducts in Babies Go Away on Their Own?

Most do.

The majority of congenital nasolacrimal duct obstructions resolve spontaneously during the first year of life as the tear drainage system matures and the membrane causing the blockage opens. AAPOS reports that approximately 90% clear during the first year.

For this reason, babies with typical symptoms often do not need an immediate procedure.

Our pediatric ophthalmologists consider the child’s age, severity and frequency of symptoms, examination findings and how the condition is progressing when deciding whether continued observation or treatment is appropriate.

Tear Duct Massage for Babies

Your pediatric ophthalmologist may recommend tear duct massage, sometimes called Crigler massage, for an infant with a blocked tear duct.

The purpose isn’t simply to wipe mucus away. Proper massage applies pressure over the tear drainage system and may help encourage the membrane causing the obstruction to open.

Technique matters. Parents should be shown where and how to massage, because rubbing the skin near the eye isn’t the same as applying pressure to the tear drainage system.

If your child is diagnosed with a blocked tear duct, our team can explain whether massage is appropriate and demonstrate various techniques.

When Does a Blocked Tear Duct Need Treatment?

Because so many congenital blocked tear ducts resolve naturally, treatment decisions involve balancing two things:

giving the tear duct an opportunity to open on its own and recognizing when continued waiting is becoming less likely to solve the problem.

A procedure may be considered when the blockage persists beyond infancy, symptoms are particularly troublesome, infections or significant discharge recur, or the child’s individual circumstances make intervention appropriate.

There isn’t one treatment age that’s right for every child. Our pediatric ophthalmologists consider the child’s age, symptoms, examination and clinical course when recommending whether—and when—to intervene.

Tear Duct Probing for Children

When a blocked tear duct doesn’t open naturally, nasolacrimal duct probing is a common treatment.

During probing, the ophthalmologist gently passes a very thin instrument through the child’s natural tear drainage pathway to open the obstruction.

The goal is to restore a pathway for tears to drain normally from the eye into the nose.

In younger infants, probing can sometimes be performed in the office depending on the physician, child and circumstances. In older babies and children, the procedure is commonly performed under anesthesia so the child remains still, comfortable and safe while the delicate tear drainage system is treated.

What If Tear Duct Probing Doesn’t Work?

Most children with a straightforward congenital blocked tear duct do well after appropriate treatment, but not every obstruction is identical.

If symptoms persist after probing, our pediatric ophthalmologists reassess the tear drainage system and determine whether additional treatment is needed.

Depending on the child’s anatomy and previous treatment, options can include another probing, placement of a small silicone tube or stent within the tear drainage system, or other procedures designed to open or maintain the drainage pathway.

Children with persistent, recurrent or more complicated obstruction may require a more individualized surgical approach.

This is one area where experience matters: the goal isn’t simply to “probe a tear duct,” but to understand why a particular child’s drainage system remains obstructed and choose the appropriate next step.

What Is Tear Duct Intubation?

Tear duct intubation involves placing a very small silicone tube through the tear drainage pathway.

The tube temporarily helps maintain an open drainage passage while the area heals. It is generally used for selected children with persistent obstruction, including some children whose blockage has not resolved after probing.

The tube isn’t visible like an IV or catheter hanging from the child’s face. It sits within the tear drainage system and is later removed.

Your pediatric ophthalmologist will determine whether intubation is necessary based on the child’s age, anatomy and previous treatment.

Is Blocked Tear Duct Surgery Painful for Children?

Parents understandably worry about discomfort whenever a procedure involves their baby’s eye.

Tear duct procedures are performed with the child’s comfort and safety in mind. When anesthesia is required, the child is asleep during the procedure.

Afterward, some children may have mild irritation, tearing or a small amount of blood-tinged tearing or nasal drainage for a short period. Your surgical team will provide specific instructions about what to expect and when to call.

When Should I Be Concerned About My Baby’s Blocked Tear Duct?

Contact your child’s healthcare provider promptly if you notice symptoms that don’t seem typical of a simple blocked tear duct, particularly:

• Significant redness of the eye
• Swelling, redness or tenderness near the inner corner of the eye
• Fever associated with swelling around the tear duct
• Significant pain or persistent eyelid squeezing
• Strong sensitivity to light
• A cloudy-looking cornea
• An eye that appears unusually large
• A sudden significant change in symptoms

A painful, red swelling over the tear sac near the inner corner of the eye can represent dacryocystitis, an infection of the tear drainage system that requires prompt medical treatment.

Pediatric Tear Duct Expertise at Children’s Eye Care

A blocked tear duct may be common, but babies and young children aren’t simply small adults.

Children’s Eye Care has specialized in pediatric ophthalmology in Metro Detroit since 1973, and our physicians routinely evaluate tearing, discharge and tear drainage disorders in infants and children.

Our pediatric ophthalmologists understand both sides of blocked tear duct care: knowing when a baby can safely be observed and knowing when it’s time to intervene.

They also have the surgical expertise to manage children whose obstruction does not resolve naturally—from routine tear duct probing to more persistent or complex tear drainage problems requiring additional treatment.

Just as importantly, we look at the whole eye, not only the tear duct. When a baby’s symptoms don’t fit the typical pattern of congenital nasolacrimal duct obstruction, our pediatric ophthalmologists can evaluate for other childhood eye conditions that may cause tearing.

That combination of pediatric diagnosis, long-term experience and surgical management allows families to receive care from the same pediatric eye team from the initial evaluation through treatment when treatment becomes necessary.