Ask Dr. K: Flush baby's tear ducts to prevent infection

Dear Dr. K: My infant has already had three tear duct infections. What's causing them, and how can I prevent another one?

Dear Reader: At the inner corner of each eye is a tiny little sac where tears are made. Some of the fluid bathes the eye. The rest of the tears travel through the tear duct, which empties in the nose. That's why, when you cry and make a lot of tears, you also get a stuffy nose and have to blow your nose to clear it out.

A tear duct can get infected if it becomes blocked and bacteria collect in the ducts or the lacrimal (tear) sac. The blockage might be from some grains of dried eye discharge — the stuff that "Mr. Sandman" creates at night, and that we discover upon awakening.

Tear duct infections can occur at any age, but they are most common in infants. That's because the center of the duct is very narrow, which makes it more easily obstructed. As the child grows, the passageway widens. As a result, most children outgrow this problem by the time they are 1 year old.

Tear duct infections can cause pain, redness and swelling. Your infant may also have excessive tearing, pus or discharge from the eye, and a fever.

If a tear duct infection is not treated quickly, it can become more difficult to cure. The infection should be treated when there is redness or fever and tears become cloudy. Antibiotics, taken by mouth, are the standard treatment; the infection should go away quickly with antibiotic therapy. Your doctor may also prescribe antibiotic ointment or eye drops.

If the infection does not respond to antibiotics, or if infections keep returning, it's a sign that there is some obstruction in the narrow tear duct. To eliminate that obstruction, the doctor guides a thin wire through the tear duct to clear out any blockage. Rarely, a more extensive surgical procedure is necessary.

There are some simple things you can do to reduce the chance that your baby will develop another tear duct infection. The first is to promote the drainage of tears each day. Be sure to wash your hands thoroughly before you begin.

First, place your index finger sideways along the bony ridge beneath your infant's eye, with your finger pointing toward the top of the nose. Firmly, but gently, apply pressure with your fingertip between the eye and nose. This pressure will compress and empty the tear sac. The tears will empty onto the surface of the eye, and they also will flush the duct below. After this, press a warm, clean, wet washcloth to the same area for a minute or two.

By flushing the tear ducts daily, you reduce the chance that the duct will become blocked. That, in turn, reduces the risk of infection. By the time your baby becomes a year old, this risk will greatly diminish anyway. Then you won't need to flush the tear ducts daily.


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