Dr. Manoj Zalte
MBBS, DCH, DNB (Pediatrics)
Pediatrician - Hadapsar, Pune
Member – Indian Academy of Pediatrics
Member – American Academy of Pediatrics
Contact No: 8446176770
Sanmay Child Healthcare
Children's Medical Home
Nasolacrimal duct obstruction (NLDO) in babies
(Blocked tear-duct, “watering eye”)
1. Quick guide for parents (1-minute read)
What you’ll notice | Why it happens | What you can do at home | When to call the doctor |
Constant watering or a sticky film on one or both eyes, especially after naps | A paper-thin membrane at the nose end of the tear-duct has not opened yet, so tears overflow | • Wipe lids with clean cotton + cooled boiled water• Crigler massage ↓ (4-5 firm downward strokes from the inner corner of the eye to the side of the nose, 3-4 ×/day)• Short course of antibiotic drops only if the discharge turns yellow-green | • Eyelid redness, swelling or fever (may be an infection)• Still watering after the 9–12-month vaccination visit |
9 of 10 babies outgrow it by their first birthday | — | Keep massaging until symptoms stop | If it persists beyond 1 year, your eye doctor can open the duct with a quick probing procedure |
(Crigler massage video demo: search “tear-duct massage baby”) (Nationwide Children's Hospital)
2. Detailed notes for clinicians / advanced learners
Epidemiology & natural history
Incidence 6–20 % of neonates; ≥ 90 % resolve spontaneously by 12 months (SpringerLink)
Pathophysiology
Persistent epithelial membrane at the valve of Hasner (≈ 90 %), less often bony stenosis or punctal/canalicular anomalies.
Stagnant tears → colonisation → mucopurulent discharge; reflux through puncta irritates lid skin.
Clinical picture
Epiphora, crusting, increased tear meniscus.
Conjunctiva generally white; photophobia or corneal haze should prompt evaluation for congenital glaucoma. (AAO)
Confirm with fluorescein dye disappearance if needed.
Factors that increase severity / reduce likelihood of spontaneous resolution
Category | Examples & evidence |
Obstruction characteristics | Complete vs partial block; complex anatomy (canalicular agenesis, fistula) – linked to higher severity (MDPI) |
Age | |
Comorbidities | Down syndrome, cranio-facial anomalies, cleft palate, prematurity, maternal/perinatal infections (Pediatric Oncall, PMC) |
Inflammatory load | Repeated URTI/conjunctivitis, chronic lid hygiene issues |
Nasal factors | Inferior turbinate hypertrophy, allergic rhinitis narrowing the duct outlet |
Management – stepwise
Age / situation | Recommended approach | Key points & evidence |
0–6(–9) mo | Conservative only: lid hygiene; Crigler lacrimal-sac massage (hydrostatic pressure bursts Hasner membrane) | |
Acute mucopurulent discharge at any age | Topical chloramphenicol or moxifloxacin 3–4 ×/day for 5–7 days | Antibiotics treat super-infection but do notopen the duct; avoid chronic use (aapos.org) |
Recurrent dacryocystitis / pre-septal cellulitis | Systemic ± IV antibiotics, urgent ophthalmology referral | Consider same-day probing if abscess recurs after resolution |
Persistent NLDO ≥ 9–12 mo | Probing under brief GA or office setting (< 10 mo) | Primary success 75–90 % when ≤ 15 mo; 2 % decrease in success per additional month thereafter (ScienceDirect, MD Searchlight) |
Probing failure or child > 24 mo | Balloon dacryoplasty or silicone intubation; combined gives higher success (93 % vs 76 % in 24–36 mo group) (Nature) | |
Multiple failures / complex bony obstruction, older child (> 4 y) | External or endoscopic dacryocystorhinostomy (DCR) |
Crigler massage teaching pearls
Wash hands; use a small dab of ointment as lubricant.
Place index finger just below medial canthus; press inwards then sweep down along side of nose (firm, 1–2 cm stroke).
Repeat 5–10 strokes per session, four sessions per day.
Expect brief reflux of mucus through puncta – reassure parents.
Follow-up schedule
Review every 2–3 months until resolution or age 9–10 months.
Document parental mastery of massage.
Refer to ophthalmology earlier if any “red-flag” infection or suspicion of glaucoma.
Prognosis
90 % resolve without surgery.
Timely escalation keeps cumulative success > 95 %, minimises risk of dacryocystitis and amblyogenic lid occlusion.
Key take-home for caregivers
“Most blocked tear-ducts clear on their own. Gentle daily massage and clean-up are usually enough. If the eye turns red, swells, or is still watering after nine months, let’s have our eye-doctor take a look—they can open the duct quickly and safely.”