Congenital Nasolacrimal Duct Obstruction

One of the most demanding and technically challenging aspects of oculoplastic surgery is paediatric surgery. The tissues are smaller, they’re much less forgiving, and incisions need to be completely invisible because the skin is very soft and has no lines to hide the incisions in. The need for precision is paramount, because even the smallest error can have lasting consequences on a child’s development.


The nasolacrimal duct, also known as the tear duct, is a tiny structure that connects the eyes to the nose. It originates from two small pores in the inner corners of the eyelids, leading through a complex network of microscopic tubes into the lower nostrils.

An unobstructed tear duct is crucial for draining continuous tears that moisten and clear the surface of the eyes into the nose. Any blockage in this tubular system can result in watery eyes and an increased risk of infection due to bacterial overgrowth in stagnant tears.

Remarkably, the development of the tear duct continues even after a child is born. Consequently, approximately 5 per cent of otherwise healthy babies are born with watery eyes. In the majority of cases, up to 90 per cent, this condition resolves within the first year of life as the tear duct matures, achieving its healthy form and function.

However, for the remaining 10 per cent of infants experiencing persistent teary eyes beyond 12 months, there may be a small section of the tear duct that has not opened up, requiring attention to prevent ongoing tearing issues.

Frequently Asked Questions

Children born with a watery eye should be seen by a Paediatric Ophthalmologist so that non-invasive (non-surgical) management can be discussed with the parents. As symptoms often resolve within the first year, simple measures like specific massaging techniques can expedite resolution.

In those cases where the teary eye does not settle with a conservative approach, a consultation with a specialist Oculoplastic and Lacrimal Surgeon should be carried out.

Depending on the age of the child, the pattern and severity of symptoms and relevant medical history, it is likely that some form of surgical intervention will be of value in resolving the teary eye.

The procedure typically involves a general anaesthetic and employs a keyhole approach, accessing the tear duct with a camera through the nostril to minimise facial scarring. In most cases, a tiny silicon tube known as a stent is left in the tear duct to prevent scarring and re-blockage. The stent, invisible and unfelt by the child, is later removed, tailored to each case.

The cornerstone of any watery eye treatment philosophy should be the least invasive strategy that effectively resolves the issue. The delicate nature of the nasolacrimal system often requires only a minimally invasive intervention for most paediatric cases. Additionally, minimising unnecessary general anaesthesia is essential. Dr Koutroumanos employs a specialised form of lacrimal silicon intubation, removable painlessly in the clinic, to avoid the added risks, hassle, and costs of an extra general anaesthetic whenever possible.

Ophthalmic & Oculoplastic surgeon
Oculoplastic surgeon London


Dr Nick Koutroumanos

Dr Nick Koutroumanos is a London-based Ophthalmic & Oculoplastic surgeon, with particular subspecialty expertise in ophthalmic plastic & reconstructive eyelid, orbital and lacrimal surgery.

His private practice, based at The Hospital of St John & St Elizabeth in St John’s Wood complements his work in charge of a large NHS oculoplastics practice at the Royal Free Hospital in Hampstead.

A qualified senior trainer and Royal College Examiner in ophthalmic plastic surgery, cataract surgery and general ophthalmology, he runs an Oculoplastics Fellowship training programme that is highly sought-after by both UK and international candidates.

Kind Words from Our Patients


A true perfectionist

Words are not enough to express my sincere gratitude for the care and dedication Dr Koutroumanos put into my journey. I felt safe and secure in his hands. This is someone who truly cares about outcome and ethics of practice. A true perfectionist. I would not hesitate to wholeheartedly recommend him.

100% worth it

I had surgery a few days ago with Dr Koutroumanos for congenital ptosis. It’s early days but I don’t think it’s too early to say the results will be life changing for me in terms of confidence levels. I struggled at school due to the condition and have learnt to live with it – that is until I saw the doctor who was reassuring from the start and has just done the best job. 100% worth it and amazing to know I was in such safe hands. I can’t thank him enough.

I’m really happy with my results

I’ve recently had a brow lift and blepharoplasty with Mr N Koutroumanos. The whole process from start to finish was handled professionally and each process was very informative. I’m still at the recovery stage, so far I’m really happy with my results. Highly recommend using Mr N Koutroumanos services.