Blocked tear ducts are extremely common in infants and generally require very little intervention. Topical antibiotics are generally not indicated unless there is significant redness or swelling of the affected eye(s).
Diagnosis
History and examination is generally sufficient for diagnosis. Blocked tear ducts present as either persistent or intermittent eye discharge, which may be watery or green/yellow, often worse after a sleep with difficulty opening the affected eye(s).
Examination may reveal the above findings, and gentle pressure on the nasal bone just medially and inferior to the inner canthus will often result in expression of a clear mucoid or green-yellow discharge back into the eye.
A congenital dacrocystocoele is a far less common condition which usually presents in the first days of life as a bluish bulge below the medial canthus. Urgent referral to an ophthalmologist is required, given the potential for serious complications.
Practice points
- Antibiotics are generally not required for simple blocked tear ducts
- These are common, often recurrent, and may be bilateral
- In most cases (90%) the condition is self-limiting and resolves spontaneously.
- Referral to an ophthalmologist for probing is generally not required unless the condition persists after 12-18 months of age.
Management
Simple cleaning of the affected eye(s) with sterile water or breast milk is all that is required. Massaging the nasal bone medially and inferior to the inner canthus may help clear any stagnant discharge.
Antibiotics are indicated for a blocked tear duct only if there is significant redness of the conjunctiva or sclera, or significant swelling of the eye/eyelid. Profuse purulent discharge should be swabbed (including samples for gonococcus and Chlamydia) and empirically treated with chloramphenicol eye drops whilst awaiting culture results.
Acute
dacrocystitis (erythema, swelling, warmth and tenderness overlying the
lacrimal sac - below the medial canthus) in a young infant may require treatment
with IV antibiotics and therefore a referral to hospital.
Referral pathways
- Paediatrician
- Not generally required.
- Ophthalmologist
- Referral to ophthalmologist for consideration of probing is warranted if there is persistence of a blocked tear duct passed 12-18 months of age given the association with vision difficulties in some of these cases.
- A congenital dacrocystocoele requires urgent referral.