Blocked tear ducts: what's normal, what's not

Few weeks pass in this clinic without a baby arriving with one wet, gunky eye and a parent whose opening line is the same: is this an infection? Usually the answer is no. More than 5% of babies have symptoms of a blocked tear duct in one or both eyes, and it is one of the most common reasons a young baby is brought in to see me at all, sometimes flagged first at a baby's first eye check. It looks alarming from the outside. It is, most of the time, simple plumbing.

Why do so many babies have a watery or sticky eye?

Because the tear drainage system is the last part of the eye to finish opening. Tears do not just well up and spill; they are meant to drain away through a tiny duct at the inner corner of the eye, down into the nose. That duct starts as a solid cord of cells before birth and has to canalise, hollow itself out, usually around the time of birth. In some babies a thin membrane is left behind at the lower end, and until it gives way, tears pool in the eye instead of draining, then spill over or thicken into the crust you find on her lashes each morning.

Nothing about this means the eye itself is unhealthy. The eye is making tears normally and seeing normally. It is the drain that is slow to open, not the tap that is faulty.

Parents often ask whether they missed something at the newborn check, as if a watery eye noticed weeks later means an earlier warning sign was overlooked. It usually was not. This is a problem that can announce itself on its own timetable, sometimes in the first days, sometimes only once a baby is settling into weeks of ordinary crying and feeding, and a slightly later start is not a red flag by itself.

What does a blocked tear duct actually look like day to day?

A watery eye that stays white and calm, on a baby who is otherwise entirely herself. You will likely notice tears sitting on the lower lid or running down the cheek even when she is not crying, and crusting along the lashes after sleep, sometimes enough to glue them shut overnight. Wipe it away and the eye underneath looks ordinary: no redness, no swelling, no sign that she is bothered by it. Some days are worse than others, often flaring with a cold or after a nap, and that coming-and-going pattern is itself reassuring. An infection tends to get steadily worse. A blocked duct tends to wax and wane.

How exactly do I do the tear duct massage?

With a clean finger and a gentle but firm downward stroke over the little tear sac beside the nose, just below the inner corner of the eye. This is sometimes called Crigler massage, named after the doctor who described it, and the idea is simple: pressing down over that small sac squeezes trapped mucus out and helps the membrane at the bottom finally give way. Wash your hands first, use a soft touch rather than a poke, and work in a downward line rather than rubbing in circles. Build it into a moment you already have together, after a feed or before a nap, a few times through the day, rather than treating it as a medical procedure to dread.

It will not work overnight, and that is expected rather than a sign you are doing it wrong. Keep the habit going and give the duct time to finish the job it started before birth. If your baby squirms or fusses at the touch, a shorter, calmer attempt beats a longer, tense one; there is no prize for finishing a set number of strokes, only for keeping at it gently over days and weeks.

What tells us this is not just a blocked duct?

A change in the eye or the skin around it, rather than just the watering. A red, angry eye, the sakit mata look rather than a merely watery one, swelling on the skin beside the nose, or a hot, swollen eyelid with discharge points to an infection of the tear sac rather than a simple blockage. That is not a wait-and-see situation: it needs a doctor the same day, and a baby who is feverish or unwell with it needs emergency care, straight away. This is different from the everyday gunk we have been describing: it looks and feels like something is genuinely wrong, not just untidy.

There is also a rarer pattern worth knowing, because it is easy to mistake for the same watery eye and it is not. If your baby seems bothered by ordinary light, screws up or squeezes one eye shut, or if the clear window at the front of the eye, the cornea, looks hazy or one eye looks bigger than the other, this can point to childhood glaucoma rather than a blocked duct. It is uncommon, but it can worsen quickly, so those particular signs deserve an urgent look rather than a wait-and-see. I go through exactly what we check for at that kind of visit in how we test a baby's eyes before they can read, and a cloudy or unusually large eye belongs in the same urgent category as a white glow spotted in a photograph: worth ruling out properly rather than assuming the best.

Is it true that breast milk in the eye can clear it up?

I hear this a great deal, often from a well-meaning grandmother, and I understand exactly why it has stuck around: breast milk genuinely does contain antibodies, and it feels like a natural, gentle thing to try. But those antibodies were never designed to unblock a duct, and a membrane sitting in a tiny channel behind the eye does not respond to anything we put into it. What actually clears a blocked tear duct is the duct finishing its own development, helped along by the downward massage described above. Time and pressure, not a substance in the eye.

There is a separate, practical reason to be careful here too: any liquid introduced into the eye that is not sterile, breast milk included, can introduce bacteria into an eye that is already struggling to drain. For cleaning away the crust each day, cooled boiled water on a fresh cotton pad for each wipe is the safer choice, and it does the job perfectly well. Wipe from the inner corner outward, use a new pad for each pass, and there is no need to scrub; the crust lifts away easily once it is softened.

I try to answer this one kindly rather than dismissively, because the advice usually comes from someone who loves your baby and is trying to help in the way she once helped her own children. You can thank her for the thought and still choose the water and cotton pad instead. Both things are true at once, and neither cancels the other out.

When does a blocked tear duct need more than time and massage?

About 90% resolve on their own during the first year of life, which is why I ask most families to simply keep going with the massage and wait it out. If the watering and crusting are still there as your baby approaches her first birthday, or if symptoms are unusually severe before then, that is when we talk about a small procedure to open the duct rather than continuing to wait. It is a much smaller conversation than most parents fear when they hear the word procedure, and I would rather explain it properly, in person, once we actually reach that point, than have you carrying a worst-case picture in your head for months beforehand.

Why does this feel like such a small thing to you as a doctor?

Because it usually is, and I want you to feel that too. A blocked tear duct is one of the most grateful conditions I see in clinic: it is common, it looks worse than it is, and it very nearly always ends well without anything dramatic being done to fix it. If you keep the eye clean, keep up the massage, and know the handful of signs that mean look again sooner, you are doing everything that actually matters. The rest, in almost every case, is simply time doing its work quietly while your baby gets on with being a baby.

Common questions

References

1. AAPOS · Nasolacrimal duct obstruction (blocked tear duct) · aapos.org
2. American Academy of Ophthalmology · Childhood glaucoma · www.aao.org
3. American Academy of Ophthalmology · Eye screening for children · www.aao.org
4. American Academy of Ophthalmology · Vision screening for infants and children, clinical statement 2022 · www.aao.org

Reviewed by Dr Chan Li Yen on 26 July 2026. Next review July 2027. This article is general information and does not replace an examination.