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Blockage of the Tear Ducts

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Dacryostenosis



  • Dacryostenosis, or stenosis of the tear duct, is a congenital blockage of the tear duct, occurring in approximately 5% of babies.  In these infants, the opening of the tear duct, a passage that drains tears from the eyes into the nose, fails to open before birth.  The blockage is inside the nose, at the end of the duct.  Because tears cannot escape, they flow back into the eye, where they collect, along with dead cells from the skin of the eyelids, and dirt and dust from the environment.  This mixture results in a mucoid discharge in the eyes.
  • Because infants do not make large amounts of tears during the first few weeks of life, the condition is often not often recognized immediately after birth.

  • Mucous and discharge in the eyes, often collecting in the medial canthus (the edge of the eyelid nearest the nose)
  • Tearing of the eyes, with pressure on the junction between the nose and the affected eye
  • Lack of redness on the white part of the eye (the sclera) or the inside of the eyelids (the conjunctiva)

  • Physical examination is usually sufficient for diagnosis; the lack of any redness of the eyes indicates that the baby does not have an infection.
  • Samples of the discharge may be sent to the laboratory if there is a question about the diagnosis.

  • In the majority of cases, no treatment is necessary.
  • Most infants will outgrow the condition by 9 months of age.
  • Although it was once thought to help, massaging the duct after placing a few drops of breast milk into the eye will not hasten the resolution of the blockage.
  • In rare cases, in which the duct does not open, a minor operation can open it.
    1. An ophthalmologist (eye specialist) will thread a small wire into the duct and open the blockage.
    2. This operation is usually postponed until after the first birthday because the risks of anesthesia decline dramatically as the baby grows, and the condition is benign.

  • In very rare cases, an infection can occur within the duct.
  • Symptoms of an infection include:
    1. Development of a blue-tinged mass at the junction of the affected eye and the nose
    2. A dramatic increase in the amount of discharge
    3. Change in the quality of the discharge from mucoid to more purulent (pus-like)
  • Babies who develop an infection should be examined by their pediatrician immediately, because they often require emergency surgery.




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