What it is
Tears drain through a small tube — the nasolacrimal duct — that runs from the inner corner of the eye down into the nose. In newborns, this duct is occasionally still partly closed at the nose end. When that happens, tears back up instead of draining, and the eye gets watery, crusty, or gooey.
Tear duct obstruction is one of the most common conditions we see in babies — about 6 out of every 100 newborns have some form of it. The very good news: most of them open on their own in the first year of life.
Signs parents notice
- Persistent watery eye on one or both sides, even when the baby isn't crying
- Crusty lashes or mucus in the inner corner, especially upon waking
- Tears running down the cheek throughout the day
- Mild redness of the lower lid from constant wiping
- Repeat episodes of mild eye discharge that clear up with gentle cleaning
What's not typical of a simple tear duct obstruction: a red, painful, swollen eye; thick green-yellow discharge that doesn't respond to cleaning; or a fever. Those could signal a secondary infection (dacryocystitis) and warrant a same-day call.
How we diagnose it
Diagnosis is clinical — we make it by listening to your story and examining your baby. We'll confirm tear production, check for any lid or corneal issues, and rule out more serious causes of a watery eye like infantile glaucoma. Most of the time, a few minutes of watching is all it takes to be confident in the diagnosis.
How we treat it
For most babies, we start conservatively:
- Crigler massage — gentle downward pressure with a clean finger over the tear sac (just below the inner corner of the eye) several times a day. We'll show you the technique in the office.
- Warm compresses and lid cleaning — a warm, damp washcloth a few times a day keeps the crusting down.
- Watchful waiting — about 90% of babies with a simple tear duct obstruction open up on their own by their first birthday.
If the duct hasn't opened by around 12 months — or if there's recurrent infection — we consider an in-office probing. This is a quick procedure where we open the duct with a thin instrument. It's usually very successful on the first attempt. For more persistent cases, a probing with stent placement in a brief outpatient procedure is the next step.
What the journey looks like
At the first visit we'll confirm the diagnosis, teach you the massage technique, and give you a treatment plan. Most families check back in 3–6 months; if things have resolved, we're done. If the duct is still blocked at your child's first birthday, we'll talk about probing.
When to call us
- Your newborn has persistent tearing or gunky discharge in one or both eyes
- Crusting doesn't clear with gentle warm-water cleaning
- The lower eyelid becomes red, painful, or swollen — this can indicate a secondary infection and warrants a same-day call
- Your child is over 12 months old and the tearing hasn't resolved