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Abnormal or overflow tearing is a common condition
in infants and babies. In fact, approximately one-third
of all newborns have excessive tears and mucus. It is
also common for babies' eyelashes to stick together
after sleep, a situation that can cause the eye(s) to
become chronically infected.
How do tears drain from the eye?
Tears are necessary to lubricate the eyes. They drain
from each eye through two small openings called the
upper and lower punctum, located along the upper and
lower eyelids near the nose. They then flow through
the canaliculus into the lacrimal sac located under
the skin on each side of the nose.
From the sac, the tears are pumped by the blinking
action of the lids into the tear duct. These ducts go
through the side bones of the nose and empty the tears
into the back of the nose. That's why your nose may
run when you cry.
Tear Drainage System
What causes overflow tearing?
Overflow tearing in children is usually caused by the
presence of a persistent membrane that blocks the lower
end of the tear duct near the nose. Normally this membrane
stretches or pops open before birth. In many infants,
however, it remains closed, clogging the tear drainage
system. The blockage may open spontaneously in a few
months as the infant grows.
Are there other causes of tearing?
Very rarely, tearing can be caused by congenital glaucoma,
a serious condition. There are other signs and symptoms
associated with congenital glaucoma, such as an enlarged
eye, a clouded cornea, high pressure in the eye, light
sensitivity, and irritability. Tearing can also be caused
by wind, pollen, smoke, or other eye irritation.
How is overflow tearing treated?
Initially, your doctor may recommend antibiotic eye
drops or ointment used once or twice daily, along with
pressure (or massage) over the tear sac. To apply pressure,
place a finger under the inner corner of the infant's
eye next to the nose, and roll the finger over the bony
ridge while pressing down and in against the bony side
of the nose. This expresses mucus and tears from the
sac. Following pressure on the sac, place an antibiotic
in the eye. Most tear blockage in infants disappears
by six months of age. if the tearing persists, it may
be necessary for the ophthalmologist to open the tear
ducts by passing a probe through the tear drain.
How is probing of the tear ducts performed?
In the first few months of life, probings may be done
in the office, without anesthesia. A thin, blunt metal
wire is gently passed through the tear drainage system
to open the obstruction. Fluid is then irrigated through
the system into the nose to ensure that the pathway
is open.
Infants experience no pain after the probing but some
blood-staining of the tears or nasal secretion is common
and a discharge from the eye may be present for several
days. Antibiotics may be prescribed. Obstruction can
recur and additional procedures may be required.
If probing is not successful, a balloon catheter or
a silicone tube can be placed in the drainage canals.
These are longer procedures than probing and require
general anesthesia. Occasionally, further surgery is
needed to bypass the blocked tear duct and create a
new opening through the bone into the nose.
What complications can occur with treatment?
As with any surgical procedure, there is the possibility
of infection or bleeding. Scarring can re-obstruct the
opening, requiring additional surgery. Chronic obstruction
can lead to infections of the tear sac at any age.
Why are regular medical eye examinations important
for everyone?
Eye disease can strike at any age. Many eye diseases
do not cause symptoms until the disease has done damage.
Since most blindness is preventible if diagnosed and
treated early, regular medical examinations by an ophthalmologist
are very important.
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