Blocked Tear Duct in Children

Babies usually don’t make tears for at least a few weeks after birth. After that time your child may have a blocked tear duct if they have:

• Eye mucus or discharge with a yellowish color.
• Redness or crusting around their eye.
• Tears that build up near the inner corner of their eye but don’t drain.
• Tears that run down your their cheek when they’re not crying (epiphora).
• Crusting and discharge on their eyelashes when they wake up in the morning.

At your child’s first appointment, their provider will take a close look at their eyes and nose and may recommend some tests.

Tear drainage test

We put an eye drop containing dye into each of your child’s eyes. Then we watch to see whether the dye drains out of their eye within five minutes. If it doesn’t, your child may have a blocked tear duct.

Eye imaging

We put an eye drop that contains a harmless dye into your child’s eye. We see where the dye goes and look for any blockages by using a CT scan, MRI or X-ray.

Meet our blocked tear duct team

A pediatric ophthalmologist will lead your child’s care team at Cleveland Clinic Children’s. They might also see physician assistants or nurse practitioners.

Sometimes, blocked tear ducts go away on their own, especially if your child is a newborn. This can happen as their tear ducts mature in the first six to 12 months of their life.

If your child’s tear duct don’t clear up on their own, we can show you how to massage their eyelid. Gently doing this two or three times a day can help open their blocked tear duct. And if these issues still don’t go away, we’ll work with you to design a personalized care plan to help relieve their symptoms. There are several different treatments we can try.

Medications

If an infection is causing your child’s blocked tear duct, we may prescribe antibiotic eye drops or ointment to help treat it.

Dilation, probing and flushing

We’ll enlarge (dilate) tiny openings around the inner corner of your child’s eye (puncta) with a special instrument. These openings connect to your child’s tear ducts. Then, we’ll insert a small probe through their puncta and flush saline (saltwater) solution through their tear ducts to clear out any blockages. Your child will get general anesthesia and be asleep while this is happening, so they won’t feel any pain or discomfort.

Stent

Your child’s provider will thread a tiny, thin tube (stent) through your child’s puncta so their tears can drain through the stent. They’ll usually keep the stent in place for about three months. Your child will get general anesthesia and be asleep when we put the stent in and when we take it out.

Balloon catheter

After your child gets general anesthesia and is asleep, we’ll insert a catheter (thin, flexible tube) with a deflated balloon on the end of it into your child’s nose. When the catheter reaches their tear duct, we’ll inflate the balloon several times until it clears the blockage in their duct.

Surgery

Your child’s provider may suggest surgery if there’s still blockage after going through other treatments or if your child has a tumor that’s causing a blocked tear duct.

We usually only do surgery if your child is over the age of 1. Your child will be given general anesthesia and be asleep during any type of tear duct surgery (dacryocystorhinostomy or DCR). During DCR, our surgeons will make a new way for tears to drain out of your child’s nose. There are two ways they can do this:

• Endoscopic DCR: Your child’s provider will insert a tiny camera and surgical instruments through their nose and into their tear duct to remove the blockage.
• External DCR: We’ll make a small cut (incision) on the side of your child’s nose. Then we’ll create a new passageway from their lacrimal glands — which make tears — to your child’s nose. Our surgeons keep the passageway open with a temporary stent. We’ll remove the stent three to four months later.

In rare cases, we might find that we need to reconstruct your child’s entire tear drainage system (conjunctivodacryocystorhinostomy). During this surgery, we create a new passageway from your child’s puncta to their nose.

Recovery after eye surgery

After basic surgery for a blocked tear duct, your child can usually go home the same day. We’ll give you eye drops or eye ointment to use while their eye heals. Tear drainage system reconstruction and surgery to remove a tumor can have longer recovery times. We’ll give you specific instructions for recovery depending on the type of surgery your child has and their needs.

Routine follow-up care

After treatment ends, we’ll continue to follow up with your child. If they get another blocked tear duct, we’ll be able to catch it quickly and take care of it right away. If your child has had surgery, we’ll also see them on a regular basis to make sure they’re healing properly.

Taking the Next Step

Tears don’t always mean your child is out of sorts. They can be a sign of other problems, like a blocked tear duct. And because this condition is highly treatable, your child doesn’t need to live with it. Our pediatric ophthalmology providers will take the time to create a personalized treatment plan that works best for your child.