Nasolacrimal duct obstruction sticky and-or watery eye

  • The following pre-referral guideline covers nasolacrimal duct obstruction (sticky/watery eye). Please see other ophthalmology guidelines as needed including Abnormal pupil reaction and size, Abnormal red reflex/white pupil or Decreased visual acuity.

    See resources for referral form, parent information and more.

    Initial findings and when to refer

    • Birth - 2 weeks - acutely sticky eye with severe amounts of discharge:
      • IMMEDIATE REFERRAL - to ED

    • Neonates - with visible dilation of lacrimal sac and bluish discoloration of overlying skin:
      • IMMEDIATE REFERRAL - for sepsis concerns - to ED

    • Ages 2 - 12 months with chronic tearing and discharge:
      • Referrals for probing are not accepted until patients are over 12 months of age unless discharge is severe and causing skin irritation. Treat medically (as outlined below).

    • 12 months onwards - patients with increased tearing that persists past 12 months of age:
      • Treat medically (as outlined below). 
      • Refer only if symptoms persist for more than 3 months.
      • Refer non-urgently for nasolacrimal duct probing.

    Recommended medical treatment - chronic tearing

    1. Massage the nasolacrimal sac.
    2. Keep the eye clean - wash with salt water as needed.
    3. Apply warm compresses (clean, warm washcloth held against closed eyelid for 2-5 minutes, 2-5 times per day.
    4. Apply chloramphenicol eye drops or ointment until tears become clear, as per Paediatric Pharmacopoeia

    Contact information

    RCH Switchboardtelephone (03) 9345 5522

    For clinical advice ask for:

    • Ophthalmology registrar or consultant on-call
      • Department of Ophthalmology - clinical advice (or direct dial 03 9345 5630)
      • Emergency Department - for clinical advice after hours
    For outpatient bookings fax to 03 9345 5034 (number also on referral form)
    • For urgent appointments also call 03 9345 6180

    Admission enquiries ask for:

    • General admission enquiries (or direct dial 03 9345 6172)
    • ED admission enquiries: (or direct dial 03 9345 6477)

    Resources

    References

    Paediatric Handbook (2009). Eye Conditions, Chapter 23 (pp357-368). James Elder and Peter Barnett. 8th Ed, Blackwell Publishing by the Staff of the Royal Children's Hospital, Melbourne. Australia.

    Feedback

    Please give feedback on this guideline - kids.connect@rch.org.au / telephone: (03) 9345 4645 / fax (03) 9345 4650

    Last updated

    Last update: August 2011

    Guideline developed by the RCH Department of Ophthalmology in consultation with a GP Review Group. Many thanks to the GPs involved in the review.  First published Dec 2007. Reviewed August 2009. Please read  Copyright and Disclaimer.