If your baby’s eye always looks teary and wakes up crusted shut, the tear duct may be blocked. Many cases are known to clear up on their own before the first birthday, but it helps to know how long to watch and which signs call for a visit.
Why It Happens
Tears drain through a tiny opening at the inner corner of the eye into the tear sac and then the nasolacrimal duct, which empties into the nose. In some newborns a thin membrane at the lower end of the duct has not yet opened, so tears cannot drain. This is called congenital nasolacrimal duct obstruction. Tears that pool in the area let bacteria grow, so sticky discharge is common. Unlike pink eye, the white of the eye is often fairly clear, and watering and discharge are the main signs.
EyeWiki, an AAO resource, estimates that about 90% resolve on their own within the first year of life. The AAO’s Ask an Ophthalmologist answer says massage works in infants under 1 year old, and if the problem has not resolved by then, a probe and irrigation procedure works well.
How It Differs by Age
Symptoms often show up in the first few weeks, usually in one eye, though both can be affected. Watching and doing massage and gentle cleaning is the usual approach in the first months. If tearing and discharge continue beyond 12 months, a pediatric eye doctor’s evaluation is advised. The AAO notes that ophthalmologists vary on timing: some offer probing around 9 months, others wait until a year or even 15 months. In the PEDIG study, primary probing succeeded in about 78% of children 6 to 36 months old, and some children have persistent symptoms and need further treatment.
Care at Home
The AAO disease review says compression of the lacrimal sac is the only requirement for proper massage and a downward stroke is not needed, while the AAPOS glossary describes firm downward finger pressure over the inner corner of the eye, so descriptions differ somewhat. After washing your hands, gently press the firm area beside the nose at the inner corner of the eye. The best way to learn the exact technique and how often to do it is to have your pediatrician or eye doctor show you. Wipe discharge with clean gauze or cotton dampened with lukewarm water, moving from the inner corner outward, and use a fresh piece each time. Check with a doctor before using any eye drops or rubbing the area hard.
Common Misunderstandings
First, that every crusty eye is pink eye; a blocked tear duct often causes repeated discharge without a red eye. Second, that massage is dangerous for babies; done gently and correctly, it is considered helpful. Third, that antibiotic drops must be used constantly; a doctor may prescribe them when discharge worsens, but they do not open the duct. Fourth, that after the first birthday it is too late; timing of a procedure varies by doctor and can be discussed after 12 months.
Signs That Need Emergency Care Right Away
Seek emergency care right away if the inner corner of the eye and the side of the nose become red, swollen, and tender, especially with fever or a baby who is fussy or listless, since this can mean an infected tear sac. Swelling of the whole eyelid, an eye that will not open, an eye that turns to one side, or strong sensitivity to light also needs prompt care. If it is not an emergency but the discharge turns yellow and heavy, the problem hasn’t improved by 12 months, or the white of the eye turns red, see your pediatrician or a pediatric eye doctor. Consider talking with a pediatrician if you are unsure. This information reflects general guidance for the United States; if you live elsewhere, check with a local pediatrician. This information isn’t a diagnostic tool and doesn’t replace advice from a medical professional.