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Where Do Tears Come From?

Under normal conditions, the eye stays moist thanks to tears made by glands on its surface. When the eye is irritated or emotions trigger crying, the lacrimal gland in the eye socket above the eyeball releases a burst of watery tears.

Where Do Tears Go?

Near the nose on each eyelid is a tiny opening called the punctum, the entry point for the tear drainage system. Each punctum connects to a narrow tube inside the eyelid (the canaliculus), which leads to the lacrimal sac at the inner corner of the eye. The lacrimal sac drains through the tear duct, which travels within the bone and empties into the nose.

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What Causes a Blocked Tear Duct in Children?

During fetal development, the tear duct begins as a solid column of cells that hollows out to form the nasolacrimal duct. In some babies, the duct is not fully open at birth, often due to a thin membrane blocking it, or less commonly, narrowing of the surrounding bone (stenosis). About 5% of newborns have a nasolacrimal duct obstruction (NLDO).

When the duct cannot drain into the nose, tears overflow (epiphora). The duct lining also makes mucus, which can build up when drainage is blocked, leading to a yellow-white discharge on the lashes or skin. While this does not harm the eye or vision, it can irritate the skin and be bothersome in appearance.

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What to Do If Your Baby Has a Blocked Tear Duct

Know That Most Cases Resolve on Their Own

Of the 5% of newborns with NLDO, about 90% improve naturally by 12 months. The membrane often opens on its own, or the bone grows and relieves the narrowing. For every 1,000 babies, about 50 have NLDO; by one year, only five will still have it.

Administer Antibiotics as Prescribed, When Necessary

Sometimes bacteria grow within the blocked duct. Antibiotic drops can be prescribed in these cases, but they should be used exactly as directed to avoid resistance. For infection, the typical treatment is one drop twice a day for five days, then return to massage alone.

Gently Massage to Help Manage Discharge

Until the obstruction resolves, gentle lacrimal sac massages can help push mucus and debris out. Press and release the small bump at the inner corner of the eyelids where they meet the nose. This can be done before each diaper change to keep symptoms under control. While massage won’t cure the blockage, it reduces discharge until the duct naturally opens.

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Trusted by Pediatricians, Chosen by Families

At The Pediatric Eye Center, we’re honored to be the trusted referral for pediatricians across Queens, Nassau County, and beyond—and the first call families make when their child needs expert eye care. Here’s why:

Decades of Experience, Gentle Care

Dr. Lichtenstein has been providing expert pediatric eye care since 1999. In that time, he’s treated tens of thousands of infants, toddlers, and teens with a blend of clinical skill, surgical precision, and warmth. With over 25 years of experience and a trademark sense of humor, he brings calm confidence to every appointment.

Visits That Kids (Surprisingly) Enjoy

From silly voices to stuffed animals to well-timed dad jokes, Dr. Lichtenstein tailors every exam to your child’s age and personality. Young kids get play-based distraction, tweens get honest conversations, and teens get the respect they deserve. He’s seen it all—and he knows how to keep kids at ease.

Clear Communication, No Surprises

We believe that clear, honest communication builds trust. That’s why Dr. Lichtenstein takes time to explain his findings, outline your child’s treatment options, and answer any questions along the way. Whether you're navigating a diagnosis or preparing for surgery, you’ll always know what to expect and why it matters.

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Infant Tear Duct Obstruction Treatment in Queens & Nassau County When At-Home Treatment Isn’t Enough

Opening the Blockage

Surgical probing uses a thin metal instrument to open membranes and assess whether the surrounding bone is too tight. When infants between six and nine months old can be held still, this can often be done safely in the office.

Why In-Office Treatment Works Well

Office probing offers about a 95% immediate cure rate, avoids general anesthesia, reduces the need for drops and massage, and saves time and cost compared to an operating room procedure.

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I was so worried and anxious going into this appointment. Would the doctor have patience for a two-year-old? How would they possibly really know what was going on with his eyes? The questions and worries were high. This doctor was absolutely fantastic!!!!!! He was upbeat and fun, worked sooo well with my son. Had patience, toys, cartoons, and an awesome sense of humor. He really made me feel so lucky to have my son seen by him. I would recommend 100x. We saw Dr. Eric Lichtenstein. Really wonderful doctor.

Noelle C.

How Is a Nasolacrimal Duct Probed?

A rounded-tip wire probe is inserted into the punctum and canaliculus, then directed into the duct until it reaches the area beneath the inferior turbinate (a bone inside the nose).

If the turbinate presses against the duct, tears can’t drain; in some cases, the bone is gently fractured out of the way without removal. This does not alter the nose’s appearance.

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FAQ Tear Duct Obstruction

Is there an alternative to in-office probing?

The alternative is to wait for spontaneous resolution. If there is no spontaneous resolution by 13-14 months, the NLDO is unlikely to resolve on its own and a trip to the operating room is the only way to fix it.

What are the risks?

The risks of in-office probing include failure to achieve cure, infection, nosebleed, discomfort, and damage to the nasolacrimal drainage system; these same risks apply when the procedure is performed in an operating room. If, at the time of in-office probing, it becomes unsafe to proceed (baby moves too much, etc.) then the procedure is immediately stopped.

Is the in-office probing procedure painful?

Probing the nasolacrimal duct on a person who is awake is not painful, but it is by no means a pleasurable sensation. Adults with tear duct problems are routinely probed in the office and most describe it feeling like soda bubbles going up the nose.

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What If the NLDO Doesn’t Go Away on Its Own by My Baby’s First Birthday?

If an obstruction remains beyond 13–14 months, probing in the operating room may be considered, as older infants are too active for in-office treatment. The success rate after 13 months is about 75%, likely because persistent cases often involve multiple membranes or bone narrowing. The exact cause can only be determined by the surgeon during probing.

Tear Duct Stent Surgery 

In the operating room, a silicone tube (stent) is usually placed within the tear duct. This tube (ideally) stays in place for six months; we remove it in the office. The silicone tube sits flush within the opening in the eyelid (canaliculus), and the child feels nothing. The tube is completely external to the eye and is not sewn into anything.

The risk of general anesthesia is minimal for a healthy baby. Nasolacrimal stent surgery carries a small risk of complications, including failure to fully resolve the blockage, infection, nosebleed, discomfort, or damage to the tear drainage system—but these outcomes are rare.

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Balloon Dacryoplasty

This procedure widens the tear duct from the inside. A deflated balloon is inserted into the duct, inflated to push open the blockage, then deflated and removed.

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When Is Balloon Dacryoplasty an Option?

At the start of each NLDO surgery, Dr. Lichtenstein probes the duct to determine the cause of the blockage. If bone narrowing is present, balloon dacryoplasty may be the preferred method. It is also commonly used after a stent procedure has not succeeded.

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Ensure Your Child’s Comfort and Eye Health

If your child shows signs of NLDO, it’s essential to seek treatment early. Contact us today to schedule a consultation for infant tear duct obstruction treatment in Queens and Nassau County, and discover how correction procedures can improve your child’s vision and appearance.

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Trusted by Pediatricians, Chosen by Families

We’re honored by Queens and Nassau County pediatrician referrals. Here’s why our patients’ families also recommend The Pediatric Eye Center:

We Offer Outstanding Medical Expertise 

Dr. Eric Lichtenstein is a well-regarded pediatric eye surgeon. His 25+ years of clinical expertise and surgical experience position him to provide excellent pediatric eye care.

We Offer Kid-Friendly Eye Care

We love providing our infant and child patients with the same care we’d give our own children. Several team members have also obtained intensive pediatric training that enhances their patient treatment skills.

We Never Compromise Our Honesty and Integrity

We always provide our patients with the treatment that’s best for them. As an independent practice, The Pediatric Eye Center isn’t bound by corporate regulations or insurance restrictions. Dr. Lichtenstein combines over two decades of patient care experience and a genuine love for his patients to make every treatment decision.

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Parents naturally want the best NLDO resolution for their baby. The Pediatric Eye Center’s Dr. Eric Lichtenstein brings decades of clinical and surgical expertise to each NLDO case and is known for his commitment to excellence in every aspect of treatment. Dr. Lichtenstein is also fiercely dedicated to a positive outcome for every young patient. If your child is struggling with a blocked tear duct, call us today at (929) 588-8570 to schedule an evaluation for infant tear duct obstruction treatment in Queens and Nassau County.

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Trusted by Pediatricians. Chosen by Families.

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