Nasolacrimal Duct Obstruction

Tears contain water, oils and mucus. Excess tears usually drain out through little holes in the edge of our eyelids. The tears pass into a space called the lacrimal sac and then down a tube called the nasolacrimal duct into our nose and are eventually swallowed. 

What is Nasolacrimal Duct Obstruction

In early childhood, the nasolacrimal duct is often not completely open. There can still be little membranes of tissue blocking the passage. If this occurs, the tears have nowhere to go and they fill up the nasolacrimal sac.  The sac then contains this sticky mixture of water and mucous and sometimes a few bacteria. The only way this sticky mixture can escape is back out though the little holes in our eyelids. This results in constant sticky discharge from the eye. It is worst when the baby cries and squeezes it all out or if the baby has a cold causing extra tear production. In nasolacrimal duct obstruction, the white part of the eye remains white and the skin is the normal colour with no swellings under the skin.

 

Nasolacrimal Duct obstruction is very common in Children under 1 year of age. It nearly always gets better by itself (98%).  It doesn’t cause any long term problems. 

Massage and Cleaning

The way to treat it is to frequently massage over the nasolacrimal sac. This is located between the child’s eye and nose. This way you can stop too much of the sticky mixture collecting, and encourage the contents to go down the correct route. Antibiotics are not needed for nasolacrimal duct obstruction.   

When do we need to do more than massage and cleaning?

If the white part of the eye becomes red, that indicates that there is also conjunctivitis and the patient should be treated with antibiotic drops.

 

If the skin over the nasolacrimal duct becomes red and swollen, this indicates an infection called dacryocystitis. In this case the child needs antibiotics and should see an ophthalmologist.

What if it doesn’t get better by itself?

In the few cases where this continues past the age of 1 year, you should be referred to an ophthalmologist (Eye doctor). They may arrange a procedure to open up the ducts.  This procedure should not be performed before this stage, as most of the children will get better by themselves. 

Naslolacrimal Duct Insufficiency

In some cases the duct isn't completely blocked but is narrower than it needs to be. In these cases the child will have periods when they have no symptoms. They get intermittent symptoms especially if they have an upper respiratory tract infection. This is nasolacrimal insufficiency. This will usually improve as the child grows. It is more common under the age of 4 years.

NLDO