Congenital Tear Duct Obstruction (Dacryostenosis)

dacryostenosis

A common situation encountered by parents with newborns is the presence of eye discharge.  This can certainly be concerning and often warrants a visit to their primary care provider’s office. The first thought that many parents have is that their baby must have an eye infection, and sometimes that is the case.  But most of the time, newborn babies have a benign condition of tear duct obstruction called dacryostenosis.  Often this occurs in otherwise healthy newborns that suddenly appear to have abnormal discharge or excessive tearing from one or both of their eyes.  Some days the discharge and tearing can be copious and then the next day it may resolve only to have it return a few days later or appear in the other eye.  This back-and-forth presentation of symptoms is common in tear duct obstruction.  Your baby’s provider can assess your child’s eyes and correctly determine if they have obstruction or infection.

 

Infection (not obstruction) of newborn eyes occurs occasionally and can be associated with several causes.  One of those is upper respiratory infections.  If your baby has a cold then they may also have tearing and have mild discharge from a viral infection.  These eye infections are usually treated with supportive care and gentle wiping of the eye area until the viral infection resolves.  A reminder that all newborns with fevers 100.4° and greater need to be seen and evaluated by a provider.  Another, less common, reason for newborns to have eye discharge would be the presence of chlamydia or gonorrhea.  That is why hospitals routinely administer erythromycin ointment to all newborns prophylactically.  It is very uncommon to see babies with eyes infected from sexually transmitted diseases in our clinic. Another reason for a baby with a red eye could be a corneal abrasion.  Sometimes babies get an eyelash or debris in their eye and they rub it causing a scratch to their outermost eye layer called the cornea.  Corneal abrasions appear as a significantly inflamed and irritated eye, often without discharge.  This is a challenging diagnosis to make at home and often providers use special dye and a black light (Woods lamp) to identify this cause.

 

By far, the most common reason for newborn eye discharge, in the well-appearing baby, is tear duct obstruction.  Signs that would confirm this suspicion would be: 

  • no redness of the white part of the eye (sclera)
  • no eyelid swelling
  • no redness to baby’s skin around the eyes
  • a well-appearing happy baby. 

When confirmed, the treatment of tear duct obstruction is supportive.  We will instruct families to gently clean away eye discharge with a warm washcloth.  Also, we advise to gently massage the tear duct.  Tear ducts are located in the corner of the eye closest to the nose.  Gentle pressure is applied to the corner of the eye in a downward motion towards the nose.  We recommend doing this 3 times a day until symptoms of the obstruction resolve.  Certainly, ensure you have clean hands when doing this so not to introduce infection.

 

Babies with obstructed tear ducts may continue to have intermittent symptoms for up to one year of age.  If tearing and discharge remain minimal and manageable then it is reasonable to watch for resolution for up to a year.  80-90% of babies will resolve by one year of age.  If there are still symptoms at a year of age then we refer to Ophthalmology to probe the tear duct open.

 

Occasionally babies with tear duct obstruction can develop bacterial eye infection due to the stagnant collection of tears in the eyes.  This would present itself as copious yellow/green discharge from the baby’s eye and possibly a red and inflamed appearing eye.  Parents may report that they know their baby has an obstructed tear duct but the discharge has become more significant.  For this situation, a provider may elect to prescribe antibiotic eye drops to treat bacterial infection.  Also, baby’s with tear duct obstruction can develop the relatively rare condition of an infected tear duct (dacryocystitis). The tear duct appears inflamed, red, and tender, and you likely will not have a happy baby.  This situation should prompt parents to have their baby evaluated by their provider.

 

In summary, if your newborn has eye discharge, we recommend you see your baby’s provider and establish a cause of the discharge.  From there, you can make a plan together about how to manage this condition, the steps going forward, and what to watch for.  Look forward to SEEing you in the office where dad jokes are always free of charge!