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.