Valve of Hasner: An Evidence-Based Patient Guide

The valve of Hasner is a thin tissue fold where the tear drainage duct opens into the nose. When it does not open normally—most often in newborns—it can block tear drainage and cause persistent watering, discharge, or recurrent irritation of the eye.

Overview: What Is the Valve of Hasner?

The valve of Hasner, also called the plica lacrimalis, is a small fold of tissue at the lower end of the nasolacrimal duct. This duct carries tears from the inner corner of the eye down into the nose. The valve acts as a one-way opening at the point where the duct enters the nasal cavity.

Before birth, the tear drainage system develops as a narrow channel. In many newborns, a thin membrane at the valve of Hasner remains closed temporarily. This is called congenital nasolacrimal duct obstruction, or a congenital blocked tear duct. Tears then cannot drain normally, so the eye may look watery or develop sticky discharge even when the white part of the eye is not very red.

The term “valve” can be confusing because it may bring to mind heart valve conditions. Searches for “valve guidelines PDF,” “valve guidelines ASE,” or “valve guidelines Nishimura” generally refer to cardiovascular imaging and heart valve guidance, not the valve of Hasner. The valve of Hasner is part of the eye and nasal tear drainage system.

How Tear Drainage Works

Tears are made by the lacrimal gland above the eye and spread across the eye surface with blinking. They keep the surface of the eye moist, support clear vision, and help remove small particles. Most tears then drain through tiny openings called puncta in the upper and lower eyelids near the inner corner of the eye.

From the puncta, tears pass through small channels into the lacrimal sac, located beside the nose, and then enter the nasolacrimal duct. The duct travels downward through bone and soft tissue until it opens beneath the lower nasal turbinate inside the nose. The valve of Hasner is located at this final opening.

If the membrane at this location does not open, fluid can collect in the tear drainage system. This may lead to overflow tears, mucus-like discharge, and crusting of the eyelashes. It does not usually mean that the eye is producing too many tears; rather, the tears are not leaving through their usual drainage route.

Symptoms and Causes of a Closed Valve of Hasner

A closed valve of Hasner most often affects infants during the first weeks or months of life. Symptoms may involve one eye or both eyes. Watering can be noticeable outdoors, in cool air, or when the child is crying, but it may also occur at rest. Sticky yellow or white discharge can collect along the lashes, especially after sleep.

Typical signs of a congenital blocked tear duct include:

• Persistent tearing or a tear-filled appearance of the eye
• Crusting on the eyelashes or eyelids
• Intermittent mucus or pus-like discharge
• Tears running onto the cheek without obvious crying
• Symptoms that improve temporarily after cleaning but return

The main cause is incomplete opening of the tissue membrane at the valve of Hasner before or shortly after birth. Less commonly, obstruction may result from narrowing elsewhere in the duct, unusual facial anatomy, trauma, inflammation, nasal disease, or previous surgery. In adults with new persistent tearing, the cause should be assessed rather than assumed to be the same congenital membrane seen in babies.

Discharge can develop because tears stagnate in the drainage system, allowing normal skin bacteria to multiply. However, a blocked tear duct and conjunctivitis are not identical. Conjunctivitis commonly causes more widespread eye redness, whereas a simple tear duct blockage may cause watering and discharge with little redness of the eye itself.

Diagnosis and Assessment

A clinician can often diagnose a congenital tear duct blockage from the child’s history and an examination of the eyes, eyelids, and nose. They may ask when watering began, whether symptoms are continuous, whether there has been fever or swelling, and whether the eye becomes red. The examination also helps rule out other causes of tearing, including eyelid position problems, allergy, irritation, or infection.

For most otherwise well infants, imaging is not needed. An ophthalmologist may apply gentle pressure over the lacrimal sac to see whether discharge returns through the puncta. If symptoms persist beyond the expected period, are unusual, or occur in an older child or adult, further evaluation may be recommended to identify the precise location and cause of obstruction.

It is important to seek prompt assessment for marked redness, painful swelling at the inner corner of the eye, fever, sensitivity to light, apparent eye pain, or changes in vision. These symptoms may indicate infection or another condition that needs timely treatment. A clinician may also check for conditions such as childhood glaucoma when a baby has persistent tearing together with light sensitivity or an enlarged-looking eye.

Treatment Options: Observation, Massage and Probing

Many congenital tear duct blockages resolve without an operation as the valve of Hasner opens during the first year of life. A clinician may recommend observation and regular cleaning of discharge using clean cotton or gauze moistened with cooled boiled water or sterile saline. Hands should be washed before touching the eyelids.

Some families are taught lacrimal sac massage, often called Crigler massage. This involves gentle downward pressure at the inner corner of the eye, following a clinician’s instructions. The aim is to create pressure in the drainage system that may help the membrane open. Massage should not be painful, and parents should ask for a demonstration rather than relying on online descriptions alone.

Antibiotic eye drops or ointment may be prescribed when there is significant discharge or suspected bacterial infection. They can control infection but do not by themselves open a persistent anatomical blockage. Repeated or prolonged antibiotic use without medical guidance is not recommended.

When symptoms continue, recur frequently, or are associated with complications, an eye specialist may discuss tear duct probing. This procedure is designed to pass a fine instrument through the drainage pathway and open the obstruction, often at the valve of Hasner. The best timing depends on the child’s age, symptoms, examination findings, and the specialist’s clinical judgment.

Tear Duct Probing: Candidacy, Steps, Benefits and Risks

Tear duct probing may be considered for a child with persistent congenital nasolacrimal duct obstruction that has not improved with time and conservative care. It may also be considered earlier when there are repeated infections, a significant mucocele or swelling related to retained fluid, or other clinical concerns. Adults with tearing need a tailored assessment because their obstruction may have a different cause and may require another approach.

During probing, the specialist gently dilates the small punctal opening and guides a very fine probe through the tear drainage channels into the nasolacrimal duct. The probe is used to open the membrane or narrowing. Saline may then be flushed through the system to confirm that fluid reaches the nose. In young children, the procedure is commonly performed with anesthesia so the child is comfortable and still; the exact approach depends on age, health, and local practice.

Recovery is usually straightforward. Mild watering, a small amount of blood-stained nasal discharge, or temporary eye irritation can occur shortly afterward. The care team may recommend eye drops, cleaning instructions, and a follow-up visit. Parents should contact the treating team if swelling, worsening redness, fever, persistent pain, or unusual discharge develops.

The intended benefit is improved tear drainage and fewer symptoms of watering and discharge. No procedure is risk-free: possible complications include temporary bleeding, false passage formation, infection, incomplete opening, or recurrence of blockage. If probing is unsuccessful or the obstruction is more complex, options may include repeat probing, silicone tube intubation, balloon dilation, or other lacrimal surgery chosen by an ophthalmic specialist.

Home Care, Prevention and When to Seek Medical Care

A congenital closed valve of Hasner cannot usually be prevented because it relates to normal development of the tear drainage pathway before birth. Good eyelid hygiene can make a child more comfortable while waiting for improvement. Caregivers can gently wipe away discharge from the inner corner outward with a clean pad, using a fresh pad for each wipe and avoiding shared towels.

Massage and any prescribed medicines should be used only as directed by a qualified clinician. Do not try to insert anything into the tear duct, use leftover antibiotic drops, or apply herbal products near an infant’s eye. These measures may irritate the eye or delay appropriate assessment.

When to seek medical care: Arrange a medical review for persistent watering or discharge, especially if it is not improving, affects daily comfort, or occurs in an older child or adult. Seek urgent care if there is fever, a red and tender swelling near the inner corner of the eye, marked eye redness, severe pain, inability to open the eye, light sensitivity, injury, or any concern about vision.

Acibadem International’s multidisciplinary specialists and JCI-accredited hospitals assess tear drainage concerns and provide appropriate ophthalmology care for international patients. A clinician can help distinguish a simple blocked tear duct from eye infection or other causes of tearing, and explain whether observation or a procedure is suitable.

Frequently asked questions

What is the valve of Hasner?

The valve of Hasner is a small tissue fold at the lower end of the tear duct, where the duct opens into the nose. It is part of the normal tear drainage pathway. In some newborns, a thin membrane at this site does not open promptly.

Can a blocked valve of Hasner clear on its own?

Yes. Many congenital tear duct blockages improve naturally during the first year of life as the membrane opens. A clinician may recommend observation and teach caregivers how to perform gentle massage if appropriate.

Is a sticky eye always caused by infection?

No. A blocked tear duct can cause sticky discharge because tears and mucus do not drain normally. However, redness, pain, swelling, or fever can suggest infection and should be assessed by a healthcare professional.

When is tear duct probing considered?

Probing may be considered when a tear duct blockage persists despite observation, causes recurrent infections, or has other concerning features. An ophthalmologist decides based on the child’s age, symptoms, examination, and overall health.

Does tear duct probing hurt?

The procedure is generally performed in a way that keeps the child comfortable, often with anesthesia in young children. There may be brief mild irritation or watering afterward. The care team will explain the planned anesthesia and recovery process in advance.

Are valve guidelines PDF documents related to the valve of Hasner?

Usually not. Terms such as valve guidelines ASE or valve guidelines Nishimura commonly relate to heart valve disease and echocardiography guidance. The valve of Hasner is an anatomical structure in the tear drainage system of the eye and nose.

References

• American Academy of Ophthalmology
• American Association for Pediatric Ophthalmology and Strabismus
• National Eye Institute
• Merck Manual Professional Edition

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.