Tearing in Infants and Children
Tearing is very common in newborns and infants. About one third of all newborns have excessive tearing and mucous discharge. As infants grow through the first year of life, tearing will resolve in about 90%. There are two situations that concern the eye doctor and parents: when chronic or recurrent infections develop, and if the tearing persists for over a year.
What causes tearing?
Tears are produced in the lacrimal gland. Blinking then pushes them into the puncti. They drain via the puncti through the canniliculus into the lacrimal sac. Then they go down the tear duct and into the nose. In infants and children, it is relatively common for an obstruction to exist at some point along the drainage pathway. The most common point is where the tear duct enters the nose.
There are other causes of tearing. Very rarely, tearing can be caused by a serious condition called congenital glaucoma. In that situation, the baby has high eye pressure from birth. There are usually other symptoms and signs of this condition present, such as a cloudy cornea, enlarged eye, light sensitivity, and high eye pressure.
What are the symptoms?
If an obstruction exists, overflow tearing will result. This may be seen as a persistent or frequent tear drop in the corner of the eye or tearing down the cheek.
When the tears don’t flow through the tear duct into the nose, bacteria may grow in the stagnant fluid that collects in the lacrimal sac. This can lead to recurrent infections called dacryocystitis. The child will frequently have a goopy purulent drainage, and lids will be stuck together in the morning.
How are tearing and infections treated?
Recurrent infections may be treated with antibiotic drops or ointments. Parents should try to keep the lashes free from dried secretions. This can be accomplished by wiping gently with a moist cotton swab every 30 seconds until the secretions loosen and come off.
A lacrimal sac massage technique, which can be taught to you by the doctor, can help open the obstructed tear duct during the first year of life.
Since tearing will resolve in most infants by their first birthday, the conservative recommendation is to wait until then to perform surgery if at all possible. If tearing hasn’t resolved by then, nasolacrimal probing is recommended for two reasons. First, the chance of spontaneous resolution is low at that point, and probing becomes less effective the older the child becomes.
Probing is performed in the operating room under general anesthesia by passing a probe through the duct from the puncti to the nose. This 5 minute procedure is about 90% successful in opening obstructions and curing the problem. If after a few weeks tearing or infections persist, then a secondary procedure is performed with implantation of silicone tubes to keep the drainage pathway open. The combination of these treatments is very successful overall.
