My 2 month old's left eye usually has some yellowish drainage that gets quite crusty. One doctor said she needed antibiotic drops, another said it was normal. It doesn't look normal, but I hate to give her antibiotics all the time. What should I do?

Ask your doctor if your daughter has a blocked tear duct. This is the most common problem of the lacrimal or tear system.

Our eyes are constantly bathed in a protective film of tears. Simple in appearance, tears are a marvelously complex structure. The tear film is composed of three layers. The thin outer layer, produced by the inside of the eyelids, is an oily film. The largest part of the tear structure is a middle layer of salty water, produced in the lacrimal gland. The innermost layer, produced by the conjunctiva on the front of the eye, is composed mostly of mucus. This wonderfully designed film is ideal to protect, cleanse, and lubricate the eye. It circulates across and drains down a pinpoint opening at the inside corner. Tears then flow through the nasolacrimal duct into the nose.

In many babies the nasolacrimal duct is not fully developed at the time of birth. Signs of this usually appear in the first weeks of life. The tears back up, causing wetness or pooling. As the watery layer evaporates, a soft mucoid discharge accumulates, which can then dry and become crusty. Sometimes the surrounding skin becomes red from irritation. This is not an infection.

If your daughter has a blocked tear duct, the symptoms may come and go throughout her first year of life. They will be more pronounced when she has an upper respiratory virus, or when she is exposed to wind or cold.

The primary treatment is gentle cleansing of the lids with a warm wet washcloth. Use a clean portion of the washcloth with each pass. This may be accompanied by a regimen of gentle nasolacrimal duct massage, usually 2 or 3 times a day. With a clean finger, simply rub the area between the inside corner of the eye and the bridge of the nose. Occasionally symptoms persist beyond one year of age. If they do, probing of the duct by a pediatric ophthalmologist is indicated.

Part of the function of the tear circulation is to keep the eye free of infection. Babies with a blocked tear duct are more prone to conjunctivitis (pink eye). Preventative treatment with an antibiotic ointment is appropriate in the first week of life to protect from organisms in the birth canal. Later, preventative antibiotics may be used on days when the discharge is particularly yellow-green and heavy.

If the white part of the eye appears red, an infection is beginning, and treatment with antibiotic drops should be prescribed. If the tear duct itself looks bright red, contact your doctor promptly to begin antibiotic treatment. Otherwise, this common developmental condition can usually be managed without antibiotics.