Nasolacrimal Duct Obstruction
A what?
Also known as a tear duct obstruction, a nasolacrimal duct obstruction is when the usual drainage system of one or both eyes is blocked in some way. This can lead to teary and crusted eyes.
Who gets these?
About 5% of term babies will have a nasolacrimal duct obstruction showing up some time in the first month.
What causes it?
Usually tears drain from the eyes through two openings in the upper and lower eyelids near the nose. These tears collect in the tear duct and drain through the nose. There can be many ways to block the drainage including not having the openings in the lids, having a duct that is too small or not present, or having a membrane blocking the end at the nose (this is the most common).
How is it fixed?
When your pediatrician is made aware of the problem they will do two things. First, check that the eye is otherwise normal; make sure the pupils react appropriately, that the eye doesn’t bulge abnormally, that there isn’t any irritation or pain from the eye itself. There are other, much less common, reasons for a constantly watering eye, and your pediatrician will refer your child to an ophthalmologist sooner if these are present.
Second, your pediatrician will tell you that at least 90% of these fix themselves by 8-9 mo. Wiping the eye with a clean cloth as needed keeps the lids dry and avoids a rash. Occasionally, if the white part of the eye starts to get red, antibiotic eye drops may be prescribed, but otherwise no drops are needed. Sometimes you will also be asked to do a tear duct massage a few times a day. This may help open the blockage and can help prevent infection by moving fluid around that would otherwise be sitting in the duct.
If your child’s obstruction doesn’t fix itself by the 9 month well child check, your pediatrician will probably refer your child to an ophthalmologist. At that time they may watch a few more months for resolution, or go ahead and probe the tear duct. This involves sedating your child, then passing a thin, straight probe through the duct from the eye to open up any blockages. Sometimes they will insert another probe from the nose as well. Probing the tear duct works the first time for most children. If it doesn’t there are other methods the ophthalmologist may use, including stents, balloons, or even creating a new duct if needed.
Bottom line.
Many children have persistent watery eyes. Most of the time it’s a blocked duct that will fix itself in the next 8-9 months. Sometimes it can be something different. Ask your pediatrician to be sure.
Links.
Nasolacrimal duct obstruction on aapos.
