• Nasolacrimal duct obstruction (also known as dacryostenosis) occurs in 5% of infants. This means that tears cannot drain away as they should, so tears flow out of the eye and run down the cheeks. One or both ducts can be affected.  Unknown cause. 

• Nasolacrimal duct: Tears are formed in the lacrimal gland, above the outside corner of the eye, underneath the brow bone. Each time we blink, tear fluid is swept across the surface of the eye and drains away through the nasolacrimal duct (tiny channels in the inside corner of the eye). Tears drain through the duct into the nose.

Management options

• Usually the tear duct gradually opens during the first few weeks or months of life. If a baby’s eyes are sticky or crusty on waking, this can be gently wiped away using gauze and cooled, boiled water. Consider gentle massage to clear the blockage and encourage the duct to open, by pressing gently on the outside edges of the bridge of the nose. 

• There is usually no need for treatment as majority of cases spontaneously resolve during the first several months of life. One would refer to a paediatric ophthalmologist if it fails to clear by one year. Treatment is by probing the duct to clear it. The persistent use of antibiotics should be discouraged.

• Consider referral if the duct has not opened by the time the baby is one year old for procedure to open the ducts using a tiny probe while the baby is under anaesthetic, or occasionally, insertion of a tiny drainage tube: Tear duct blockage (GOSH), Tear duct blockage in babies (Patient.info)