Friday, June 14, 2013

Blocked tear ducts

We get calls all the time from parents with a young baby who has eye discharge.
Between 5-20% of babies are born with a blocked tear duct. The medical lingo for this is dacryostenosis. You may also hear it referred to a nasal lacrimal duct stenosis.

These babies have eyes that are crusty or watery. Some discharge is noted as well. It is usually worse when they first wake up from sleep.

My favorite approach is the most natural. Reach up to your own eye. Do you feel that little bulb on the inside corner near your nose? That is the tear duct. Gently massage it. It actually feels sort of good ( okay now stop rubbing your eye)

Now it is your baby's turn.

With a very clean finger, massage their tear duct. ( watch out for sharp nails)
If you are fortunate to have breast milk, add a few drops to the eye. You can tap it in with your finger, an eye dropper or squirt it in directly.
Now clean off the eye with a warm, wet cotton ball. I was always taught to wipe from the outside towards the nose. This direction avoids spreading the mucous throughout the rest of the eye, but there doesn't seem to be any consensus about this

If you don't have breast milk, Simply do the massage and clean with the wet cotton ball.

Think about having a clogged drain, if you can clear it without pouring in DRANO that is a better option. Massaging the duct often takes care of it. The breast milk is a bonus and more and more studies are finding remarkable healing properties in it.

Kids with blocked ducts are going to have the crusty eyes on and off.
Baby seems happy and well
Eyes remain clear for several hours after treatment  
(remember, it is normal for them to be especially crusty when they first wake up)
There is no significant redness or swelling around the eye
I am fine with the "watch and see" approach.
Treat with the massage and breast milk for a day or so and then report back

If, however:
The baby seems very fussy
The eyes have green or yellow discharge that needs to be wiped off more than once an hour
There is significant redness in or around the eye
call for an appointment.( For older children, Goopy eyes can be conjunctivitis or a sign of an ear infection)
If we suspect an eye infection we will likely prescribe a course of antibiotic eye drops or ointment. 

Having a blocked tear duct is quite common. Most infants grow out of it within a few months. 90% will resolve on their own. Some kids don't clear until they are almost a year old. If it doesn't seem to be resolving or your baby is getting frequent eye infections, we will send you to see the ophthalmologist. They will schedule a simple procedure that unblocks the duct.

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