Eye discharge in newborns: blocked tear duct, and when to see the doctorनवजात की आंखों से पानी या चिपचिपा स्राव: टियर डक्ट बंद होना, और डॉक्टर को कब दिखाएं

Tears drain from the inner corner of the eye through a thin tube, called the nasolacrimal duct, into the nose. In some newborns, the lower end of this tube is still closed by a thin membrane, or the tube is narrow. Tears cannot drain well, so they collect at the inner corner of the eye. This causes watering, and mucus can build up and form sticky discharge.

The eye may look wet most of the time, and it is often only one eye. The discharge is usually clear or white to yellow-white. It can start around 2 weeks of age, and it can come and go.

Common in a blocked tear duct

• Watering or a little mucus in one or both eyes, especially when the baby is crying or feeding.
• Clear or white-yellow mucus at the inner corner of the eye, which can be wiped away.
• The eye is not red, the lids are not swollen, and the baby is otherwise well, feeding and gaining weight.

Signs that need prompt review

• Redness of the white of the eye, or thick yellow-green pus.
• Swelling near the inner corner of the eye or the nose.
• Watering with the eye sensitive to light, or a cloudy or enlarged eye.
• A baby who seems unwell, feeds poorly, or has a fever.

If any of the second list appears, please see a doctor without waiting for the next routine visit. The warning signs are listed again at the end of this article.

A visit usually starts with a few questions and a careful look at both eyes. The doctor may check the eyelids, the inner corner of the eye, and the white and clear parts of the eye. Pressing gently on the area beside the nose may help the doctor see whether the duct is blocked, and whether there is swelling or pus. The doctor may also check the baby's eye movements and light response, and decide whether any other test is needed.

Please tell the doctor when the watering started, which eye is affected, what the discharge looks like, whether the baby has had a fever, and how feeding and sleep have been.

The right plan depends on the baby's age, the eye examination, and whether there is infection. Options that doctors may discuss include:

• Watching and review: regular follow-up visits to see whether the watering is settling.
• Massage shown by the doctor: only if the doctor advises it, and shown to the parent during the visit.
• Medicine for infection: eye drops, only if the doctor finds an infection and prescribes them.
• Referral to an eye specialist: for watering or discharge that continues beyond about 12 months, or sooner if the doctor is concerned. The specialist may discuss a simple procedure to open the duct, usually under anaesthesia.

Massage at home, only if your doctor advises it. If your doctor advises massage and shows you how at the visit, you can do it at home. Do not start it without that advice.

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• Wash your hands and keep your nails short. Hold your baby comfortably.
• Place the index finger on the tear sac, just below the inner corner of the eye, beside the nose. Not on the eyeball, and not on the bone of the nose.
• Press firmly but gently for 2 to 3 seconds, then slide downward towards the nose.
• Repeat 5 to 10 strokes per session, 2 to 4 times daily, or as your doctor tells you otherwise.

Do not massage while the eye is red, swollen, or has pus. Take your baby to the doctor first. Stop and see the doctor if the eye becomes red or swollen, there is pus, your baby cries in pain, or the eye looks cloudy.

• First weeks to months: watering or discharge may come and go. Keep the visit schedule your doctor gives you.
• Around 6 months: many parents notice improvement, but this varies. Continue the follow-up the doctor has planned.
• Around 12 months: the doctor reviews the eye again. If watering or discharge still continues, a referral to an eye specialist may be advised.

Every baby follows a different path, so these are only general markers, not promises.

1. Book a visit with the doctor if the eye is watering or has discharge, or if you are unsure.
2. Do not put drops, ointment or home remedies in the eye unless the doctor has prescribed them. This includes breast milk, herbal drops and any other home remedy.
3. Massage only if your doctor has advised it and shown you how. See the steps in section 4.
4. Wash your hands before you touch your baby's face.
5. Note the details to tell the doctor: when it started, which eye, the colour of the discharge, and any fever or feeding problems.

• "Something the mother did caused it." A blocked tear duct is a development matter in the baby. It is not caused by anything the parents did or ate.
• "Watering means the baby is crying too much." Watering from a blocked duct is a drainage problem. Crying can make it look worse, but it is not the cause.
• "Home drops or breast milk will clear it." Home remedies are not a treatment. Please do not put anything in the eye without the doctor's advice.
• "If it is not red, nothing needs checking." Redness is one warning sign, but other signs can appear without redness. A check-up is the only way to be sure.

• What do you think is causing the watering or discharge?
• Is there any sign of infection today?
• What is the plan for the next 3 to 6 months, and when should we come back?
• Should we do anything at home, and if so, can you show me how?
• What signs should make us come in sooner?

Is the discharge an infection?

It can be, so the doctor should check. A blocked tear duct usually causes watering and mucus. Infection can cause redness, swelling or pus.

Will it affect my baby's eyesight?

A blocked tear duct usually does not harm the eye itself. A red, swollen or cloudy eye needs urgent medical attention.

Does my baby need massage?

If your doctor advises it and shows you at the visit, you can do it at home. Do not start it without that advice.

Can I wait and see?

Some babies are followed with regular visits rather than treated straight away. This is a decision for the doctor, based on the examination. Please do not decide to wait without a visit if the eye is red, swollen, or has pus.

• The discharge is heavy, or the skin around the eye becomes sore, red or cracked.
• The watering or discharge is still present at 12 months of age.
• You are unsure whether the eye is improving.