A blocked tear duct, also known as congenital dacryostenosis, occurs when the tear drainage pathway from the eye to the nose is obstructed. This condition is common in newborns. The primary cause is that the lower end of the nasolacrimal duct has not fully opened after birth, or a thin membrane remains unopen. As a result, tears accumulate instead of draining normally, leading to frequent watery eyes and discharge in the corner of the eye.

Symptoms typically emerge within the first few weeks after birth. Affected infants often experience watery eyes, even when not crying, with tears frequently overflowing onto their cheeks. White or yellow discharge is common in the corner of the eye and reappears quickly after wiping. Some babies may also have sticky eyelids in the morning. Gently pressing the inner corner of the eye, near the bridge of the nose, can sometimes reveal mucus or pus emerging from the tear punctum.

Most blocked tear duct cases are not dangerous and often resolve naturally as the tear drainage system matures. Approximately 90% of infants overcome the blockage within their first 9 months. However, persistent tear accumulation can foster bacterial growth, potentially leading to dacryocystitis, an inflammation of the tear sac. When this occurs, infants might show redness and swelling in the inner corner of the eye, pain, significant pus discharge, fever, or increased fussiness. Severe infections could spread to surrounding eye tissues, necessitating emergency medical attention.

For a two-month-old infant, conservative treatment is typically the initial approach. Parents should maintain eye hygiene by gently wiping the eyes with a clean gauze pad or cotton ball soaked in physiological saline solution. Always wipe from the inner corner outwards, using a separate pad for each eye.

Proper tear sac massage can also help increase pressure within the tear duct, assisting in opening the blocked membrane at the lower end of the nasolacrimal duct. Parents must wash their hands thoroughly before placing a finger at the inner corner of the eye, directly above the tear sac. Then, firmly stroke downwards along the bridge of the nose. The frequency and technique of massage should follow the doctor's specific instructions.

A doctor examines an infant's eye. Illustration: Tam Anh General Hospital

Parents should not administer antibiotic or corticosteroid eye drops without a doctor's prescription. If the condition persists after two to three months of conservative treatment, a doctor may consider tear duct irrigation or probing. These procedures are typically considered for older infants if the tear duct does not open spontaneously, with the approach depending on the specific situation.

Parents should seek early medical attention if their child's watery eyes and discharge persist without improvement, or if symptoms include redness and swelling in the inner corner of the eye, significant pus, fever, refusal to feed, excessive fussiness, or general eye redness. Timely diagnosis and appropriate treatment are crucial to prevent infection and protect the child's eye health and vision.

Dr. CKI Le Thi Huong Giang

High-Tech Ophthalmology Unit

Tam Anh Cau Giay General Clinic