Blocked tear duct in babies

08/01/2026

Congenital nasolacrimal duct obstruction (CNLDO) is the most common disorder of the tear drainage system in children under one year of age. Below, we explain its symptoms, how it is diagnosed, and what treatment options exist, ranging from massage to surgery, if necessary.

Why does tear duct obstruction occur in babies?

Normal functioning of the tear drainage system

The lacrimal gland is responsible for producing tears, which clean and keep the eye hydrated. After cleaning and lubricating the eye, tears drain into the nose through the tear drainage system.

Cause of tear duct obstruction in babies

At birth, some babies have persistence of a membrane at the end of the tear duct (at the level of the valve of Hasner), which causes a mechanical obstruction of the drainage pathway. This is one of the most common causes of congenital nasolacrimal duct obstruction (CNLDO). The obstruction may be unilateral or bilateral.

What are the symptoms of tear duct obstruction in babies?

The most common symptom is watering of the eye (epiphora), which usually attracts attention because it is visible even when the baby is calm, and may worsen with cold and wind. At times, dry crusts on the eyelashes, discharge, recurrent conjunctivitis, and occasionally irritation of the eyelid skin may be observed, as constant watering irritates the skin and babies may rub their eyes. These symptoms appear from birth or during the following days or weeks.

How is congenital tear duct obstruction diagnosed?

Medical assessment and differential diagnosis

If we suspect that a baby may have CNLDO, a consultation with a paediatrician and/or ophthalmologist can be arranged to rule out other, less common causes of watery eyes.

Treatment of tear duct obstruction in babies

Conservative treatment during the first year

CNLDO generally resolves spontaneously during the first months of life, especially within the first six months. Nevertheless, we advise families to help the tear duct open during the first year by performing Crigler massage. This is a very simple and painless technique; it is carried out by sliding a finger downwards over the area of the tear duct while applying pressure, with the aim of “breaking” the membrane by increasing hydrostatic pressure within the lacrimal sac. We also recommend cleaning the eye with saline solution.

On rare occasions, antibiotic eye drops may be prescribed.

Surgical intervention if there is no improvement

In most patients, the tear duct opens before the age of one year. However, if symptoms persist beyond this age, the paediatrician will refer the child to a paediatric or oculoplastic ophthalmologist.

Depending on the child’s age and the evolution of the condition, different surgical techniques may be indicated. The obstruction can be relieved by probing (using a thin, wire-like instrument), by probing combined with intubation using a silicone tube that is later removed, or by using a balloon catheter, which is inflated to dilate and open the duct.

In very few cases, dacryocystorhinostomy surgery (DCR) is required. This is indicated when there is a severe infection of the lacrimal sac or when the previously mentioned methods have failed.

Blocked tear ducts in babies usually resolve spontaneously during the first months of life. At the Barraquer Ophthalmology Centre, we understand families’ concerns, and for this reason we offer a personalised and progressive approach: from massage to the most advanced surgical techniques, only when strictly necessary.

Dr Rob van der Veen, ophthalmologist at the Barraquer Ophthalmology Centre