Blocked Tear Duct and Sticky Eye in Babies

When to get help

A baby under 30 days old with red, sticky eyes needs an urgent appointment. The NHS says to ask for an urgent GP appointment or call NHS 111. NICE's clinical knowledge summary calls conjunctivitis in the first four weeks of life ophthalmia neonatorum and lists it for urgent referral to an eye specialist: most cases are mild, but untreated infection, for example with gonococcus or chlamydia, can lead to sight loss and death.

Call emergency services (999 in the UK, 112 or 999 in Ireland) if your baby has a sticky eye and, in the HSE's list, is in severe pain or crying inconsolably, is listless or hard to wake, cannot open the eye because it is so swollen, is pale, mottled and abnormally cold, has pauses in breathing of more than 10 seconds, is grunting or has blue lips, has a fit, or has a rash that does not fade when pressed (see the glass test and when to call a doctor or emergency services).

The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) calls infection of the tear sac, dacryocystitis, rare but a medical emergency: a painful, red, swollen bump near the duct with yellow-green discharge, and fever or tiredness. A bluish bump at the inner corner in the first six months is a dacryocele, which AAPOS says can be linked with cysts in the nose that cause breathing problems. A red, hot eyelid is covered on a swollen eyelid in a baby.

See your GP or public health nurse if the stickiness is getting worse, the eye looks red and sore, or your baby keeps rubbing it or seems to be in pain. Mention any watery eye at a routine check, because AAPOS notes that rarer causes of tearing, such as childhood glaucoma, need ruling out. The baby health review schedule shows when those checks fall.

What a blocked tear duct looks like

A blocked tear duct gives a watery eye and a yellow or white sticky discharge. The HSE describes this "sticky eye" as common in newborns and small babies, caused by narrow or blocked tear ducts that are still developing.

Tears drain from the inner corner of the eye down a small duct into the nose. AAPOS explains that the usual cause of a blockage is a thin membrane at the lower end of the duct, present in about half of newborns, which normally opens shortly after birth. When it stays shut, tears pool and spill onto the cheek, and the lids and lashes crust with yellow-green discharge, sometimes sticking together. The discharge appears because the normal bacteria on the eyelid are not being washed away down the duct.

Symptoms come and go, and AAPOS notes they tend to flare with a cold or blocked nose, and in wind and cold weather. In a Dundee study that followed 4,792 babies through their first year, 95% of those affected had symptoms within the first month of life.

Blocked tear duct or conjunctivitis?

Look at the white of the eye. The HSE's rule for a sticky-eyed baby is to contact your GP if the whites turn pink or red, because that could be conjunctivitis.

More on red, sticky eyes, including nursery rules, on conjunctivitis in babies.

How to clean a sticky eye

• NHS (UK): boil water and let it cool, then gently wipe the eyelashes with a clean cotton wool pad to clean off crusts, one piece for each eye.
• HSE (Ireland): wash your hands, wet a sterile cotton ball with saline, wipe from the inside corner outwards with a new cotton ball for each wipe, dry the same way with a different cotton ball, and wash your hands again. Do not share your baby's towel.

Cambridge University Hospitals' paediatric eye service adds that if the lower lid gets sore from constant wetness, a little petroleum jelly waterproofs the skin and makes crusts easier to clean off.

How to do tear duct massage

Massage aims to push trapped mucus out of the tear sac and help the membrane open. The HSE suggests mentioning the sticky eye to your GP or public health nurse, who can show you how. Techniques differ in detail:

• Cambridge University Hospitals (UK): roll your little finger firmly just between the inside corner of the eye and the nose for a minute while your baby feeds, then clean away any discharge it releases.
• AAPOS (US), "Crigler massage": firm pressure with a finger in a downward motion over the inner corner of the eye.

The evidence is observational. A review of records for 1,958 babies in Olmsted County, Minnesota, found the duct cleared without surgery in 89.7% of those prescribed massage, against 74.6% of those simply observed. The babies were not randomly assigned, so this is an association rather than proof.

How long does a blocked tear duct last?

Most clear by the first birthday, though the figure depends on how a study counts. In the Dundee cohort of 4,792 infants, published in 1991, 20% had signs of poor tear drainage at some point in their first year, and 96% of those had resolved before the age of one.

The Minnesota study counted only babies whose blocked duct a doctor had diagnosed, and did not count babies who had a procedure as clearing on their own, so its figures run lower:

The rate of clearing levelled off after 9 months. Cambridge University Hospitals tells parents that symptoms have resolved in more than half of affected babies by eight months and in 95% by one year.

If it has not cleared by 12 months

The HSE says your GP may refer your baby to a specialist if the eye is still sticky after 12 months. The usual procedure is probing, passing a fine probe through the duct to open it. Cambridge describes it as a day case under a short general anaesthetic that cures about 3 in 4 cases; in the US, AAPOS notes some ophthalmologists probe babies under one in the office with numbing drops. Waiting is an alternative when symptoms are mild: Cambridge reports about 6 in 10 children still affected at their first birthday are symptom-free by two.

Frequently asked questions

Is yellow discharge from a blocked tear duct normal?

Usually, yes. The HSE says yellow or white discharge is common in newborns with narrow or blocked tear ducts, and AAPOS lists yellow-green crusting among the ordinary signs. What changes the picture is a pink or red white of the eye, a painful red bump at the inner corner, fever, or red sticky eyes before 30 days.

How long does a blocked tear duct last in a baby?

Usually months rather than weeks. In a Minnesota study of 1,958 babies, 47.3% cleared without treatment by 3 months and 78.4% by 12 months, while a Dundee study found 96% resolved before age one. If the eye is still sticky after 12 months, the HSE says your GP may refer your baby to a specialist.

Can you put breast milk in a baby's sticky eye?

The cleaning methods published by the NHS and the HSE use cooled boiled water or saline on clean cotton wool, with a fresh piece for each eye, and neither suggests breast milk. If the eye looks infected rather than simply sticky, the NHS says treatment for a child under 2 needs a prescription from a GP.