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Clogged Tear Ducts: A Common Cause Of Goopy Eyes In Newborns

I woke up this morning to find my baby’s left eye gooped shut. I probably would have been tempted to take her in thinking it was pink eye or something serious, but I’ve seen this a million times in clinic. It was a simple case of “nasolacrimal duct stenosis” (a.k.a., a clogged tear duct). I figured that if we’re dealing with it, so are other parents of newborns. Hopefully I can save you an unnecessary trip to the doctor’s office.

What is nasolacrimal duct stenosis?

The nasolacrimal duct is the drain that runs from inner corner of the eye to the nose. So when the drain gets clogged, the fluid drains out the eye instead of down through the nose. In a newborn, the little drain is so tiny, it is easily clogged. This happens off and on during the first few months of life. As a general rule, it is completely benign and resolves with time.

What are the signs?

  1. Gooping/drainage in the eyelashes and corners of the eyes.
  2. The drainage is yellow or white.
  3. Gooping is worse after the eyes have been shut for a while (first thing in the morning or after naps).
  4. Sometimes the baby will have snorty or noisy breathing, almost sounding congested even though the child isn’t sick

When to worry/Go to the doctor?

  1. The white part of the eye is red.
  2. The tissue all around the eye is puffy or swollen.
  3. There is associated fever.
  4. Your newborn is exhibiting other signs of being ill (cough, runny nose, etc.).
  5. If your baby isn’t moving his/her eye around.

How to treat it?

  1. Keep the eye clear of drainage with a clean, warm, damp washcloth (wipe from the inside out).
  2. If the skin on the outside corner of the eye is getting red and irritated, put a little Aquaphor on the skin.
  3. Duct massage is of questionable benefit (the process involves rubbing the area between the inner corner of the eye and the nose, but not the eye itself). Most of the studies state that it doesn’t help. My experience is that it generally causes more skin irritation and just makes my baby cry, so I don’t do it.

Does my baby need to see a specialist?

Rarely does a baby with a clogged tear duct need to see a specialist. An ophthalmologist, an eye specialist, usually doesn’t like to see babies with clogged tear ducts before one year of age. This is because the vast majority of the cases will clear up on their own within the first year and we never want to subject someone to a procedure (not to mention the time and money) if it would have resolved with time on its own.  Despite seeing this every day, I only end up referring one or two cases a year to a specialist because it hasn’t resolved.

How long does it last?

Most of the cases last a few days to weeks. However, some will persist for months. Most (well over 90-95% of cases) will clear up on their own within the first year of life.


In this picture, you can see all the crusted discharge (goop) in her lashes. Take note that when the eye is open though, the white part is still white and the tissue around the eye isn’t swollen.

5 Things Newborns Do That You May Not Know About

I had the privilege of seeing 5 newborns in clinic yesterday. As I found myself repeatedly talking about some of the quirky, lesser known, normal activities of newborns, I realized that there are things parents didn’t warn each other about. These are all NORMAL things in the newborn stage.

  1. Skin peeling. Babies have been swimming in “water” for 9 months. Being in so much fluid for so long, will make the skin peel in the first couple of weeks. Treat it by using a good, thick, hypoallergenic lotion a couple of times a day until it stops.
  2. Twitchy movements. Babies have a reflex called a Moro reflex. When startled, moved rapidly, or rolled to their backs, babies’ arms will quickly outstretch to the side and the hands will open wide. Their other muscles can randomly contract and twitch on occasion. Any persistent, rhythmic movement (like a seizure) should be seen by your doctor. Tip: Record with your phone those sorts of movements in case your baby doesn’t do it while you’re at the doctor’s office (that way your doctor can see if the movements are something to be concerned about).
  3. Funky breathing. Babies do something called periodic breathing. This is due to an immature nervous system. It goes away with time (first couple of months). In the beginning your baby may have short bouts where he/she breathes fast and then appears to stop breathing. These pauses can be many seconds long (think 10-20 seconds). If you aren’t aware of this quirky breathing pattern, it may make you think that your baby has stopped breathing.
  4. Gagging and spitting up. Gagging is especially true in the first couple of days of life if the baby was C-Section or a fast delivery. The baby may have remaining fluid in his/her lungs (from prior to birth) or have swallowed some of the amniotic fluid. It can take a couple of days for the baby to get all that junk out. Usually, the baby is still in the hospital during this period and the medical staff can help determine if steps (like sucking out the gunk) need to be taken to help the baby with the transition. After you get home with your baby, some spitting up is still normal. If it seems like a lot (every feed and most of the bottle), talk to your doctor.
  5. Eye rolling/crossing. Newborns have weak, eye muscles that aren’t very coordinated. It often takes a couple of months for the eyes to consistently start tracking properly. You will likely notice, more eye rolling, crossing, and wandering when the baby is tired.

As always, if there is anything you are particularly worried about, don’t be afraid to see your doctor. Hopefully knowing these normal things can save you time and co-pays. Enjoy your newborn!

Congenital or Infantile Nystagmus: The Problem Of Dancing Or Wiggling Eyes

Have you ever seen an infant whose eyes appear to dance or wiggle uncontrollably? The condition is called congenital nystagmus, or more accurately “infantile nystagmus.” Congenital means you are born with something, and technically speaking, this kind of nystagmus can appear anytime in the first few weeks-to-months after birth. So, it is referred to as infantile nystagmus.

There are different types and causes of nystagmus. I’m generally addressing the infantile form here, but for the sake of completion, note that other conditions (e.g., metabolic disorders , stroke, trauma,  tumors, etc.) can also cause nystagmus.

Visual problems

Nystagmus causes problems with vision because the brain can’t process dynamic activities like motion, depth, and contrast. The pursuit system (the part of the brain responsible for holding the eyes steady) is the area of the brain most affected. This pursuit system is supposed to stabilize the eyes when you want to look at something.


  1. Distant staring: In the very beginning (first few days-to-weeks), there may be distant staring while the infant is trying to get the visual system to work.
  2. Wiggly eyes: The actual movement is a repetitive beating to the side (if it’s “horizontal”) or up and down (if it’s “vertical”). This develops over the next few weeks. This is very easy to see, you won’t miss it.
  3. Head tilting or turning: This is done to help improve vision

How is nystagmus diagnosed?

As the parent, you won’t miss if your child has nystagmus. When your child’s eyes are beating uncontrollably, you’ll seek medical care. Your pediatrician will then help get you in to see an eye specialist, called an ophthalmologist (different than an optometrist, the ophthalmologist is a medical doctor and can perform surgery). What will the ophthalmologist do?

  1. History (what’s going on, pregnancy and birth history, family history)
  2. Physical exam
  3. Testing—behavioral and electrophysiologic testing (specific types of tests done to help evaluate different eye functions)
  4. Usually the diagnosis is one of exclusion, meaning you’ve ruled out all the other causes.


There are many treatment potentials. The ophthalmologist will explore the different options with you based on the determined cause. Options can be any of the following:

  1. Medical (medications)
  2. Optical (glasses)
  3. Surgical (on the eye muscles)

Treatment is usually most successful when initiated early. Generally speaking a “wait and watch” approach is a bad idea. It is worth noting that some types of nystagmus improve with time.

What is the long term prognosis?

Unfortunately, I don’t have a simple answer on this one. Congenital or infantile nystagmus is often (roughly 70% of the time) associated with other eye problems (e.g., lazy eye, cataract, etc.). The prognosis is entirely dependent on what else is involved in the scope of the problem.

How To Tell If Your Kid Has A Lazy Eye

A lazy eye can be an easy diagnosis to spot. Most of the time, when I walk into an exam room, I detect if a child has a lazy eye even before I sit down. I make eye contact with the child when I walk into the room, the child looks at me, and I notice that the eyes don’t track correctly. The surprising thing to me is how often parents are surprised when I bring it up.

So what is a lazy eye? The medical term for lazy eye is amblyopia. By definition, amblyopia is an eye condition that causes decreased vision that is a result of abnormal visual development. It usually affects one eye, but can affect both eyes. Lazy eye happens if the nerve pathways between the brain and the eye aren’t stimulated like they are supposed to. Consequently, the brain starts to favor the eye with better vision. The other, weaker eye tends to wander and eventually the brain ignores signals from the weak eye and it gets lazy.

Signs and symptoms of lazy eye

  1. One (or both) of the eyes wander inward or outward. (Tip: If you aren’t sure, take a picture of your kid. There will be a small light reflection seen in the colored portion of the eyes. Is the reflection in the same place in both eyes? If no, you may have a problem).
  2. Eyes that may not appear to track or work together.
  3. Poor depth perception.

Causes of lazy eye

  1. Strabismus: The muscles that move the eye are not equally balanced and can cause the eyes to cross or turn out.
  2. Deprivation: If something “deprives” the eye of clear vision (e.g., a cataract or cloudy area in the lens).
  3. Refractive error: If there is a significant vision difference between the two eyes (e.g., severe nearsightedness, farsightedness, or astigmatism).
  4. Crazy/rare stuff: I hesitate to even mention these reasons (because a worried parent will focus on the worst case scenario, but I need to include them for accuracy/completions sake). These are things like eye tumors or inner eye problems. I repeat, these are super rare.

Treatment for lazy eye

As a general rule, the earlier it is treated, the better the outcomes (because this is when the connections between the brain and eye are still forming). How lazy eye is treated depends on the cause.

  1. Glasses or contacts. These are used if the problem is nearsightedness, farsightedness, or astigmatism.
  2. Eye patches. Still used today, but less often. The idea is to strengthen the weaker eye.
  3. Eye drops (usually Atropine). The drop is used in place of a patch. It blurs the vision in the good eye, thereby hoping to improve the weaker eye. Generally utilized as a last resort if uneven eye muscles are the problem.

Age Exceptions

Do not read this and stress if your child is a newborn. The general rule of thumb is that it takes a little while for the eyes to mature/improve enough to track properly. So if your child is sub 2 months (in some cases up to 4 months is normal), it’s too early to worry.

Lazy eyes often run in families and are more common in children that were born premature. If it is missed or not treated it can cause permanent vision loss. So if you suspect it, make sure you get it checked out by a professional.