Congenital dacryostenosis is a blocked tear duct in a baby, usually because a thin membrane at the lower end of the duct has not opened yet. It is common, starts in the first weeks of life and clears on its own in most babies by their first birthday.
Key symptoms
- Constant tearing from one or both eyes since the first weeks of life
- Tears spilling over the lid onto the cheek
- Crusting or mucus on the lashes, mostly after sleep
- White of the eye not red, baby otherwise well
What you find on exam
- Watery eye with a high tear film, white of the eye quiet
- Gentle pressure over the tear sac may bring mucus back
- Red reflex in both eyes
- Cornea clear and normal size, no light sensitivity
- Look for a bluish swelling at the inner corner (dacryocele)
Tests
- Clinical diagnosis, no tests needed in typical cases
- Fluorescein dye disappearance test if unclear
- Urgent eye exam if the cornea is cloudy or large, to exclude congenital glaucoma
Treatment basics
- Reassure parents: most resolve by 12 months
- Tear sac massage (Crigler massage) a few times a day
- Clean lid crusts with warm water
- Antibiotic drops only for a true bacterial conjunctivitis
- Refer to pediatric ophthalmology for probing if still present around 12 months
Red flags
- Red, swollen, tender area at the inner corner (acute dacryocystitis)
- Cloudy or enlarged cornea, light sensitivity (possible congenital glaucoma)
- Fever or redness spreading around the eye in a young infant
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.