Babies frequently develop infected eyes with overflow tearing. It has been reported that almost one-third of newborn infants have one or both eyes that water at birth. These eyes overflow with tears and mucus. Often the lashes are stuck together after sleep and the eye(s) may become chronically infected. Ophthalmologists refer to overflow tearing as congenital stenosis of the nasal lacrimal drainage system.

How Do Tears Drain From The Eye?

Tears drain from the eyes through two small openings, or pores, located on the upper and lower lids near the nose. These openings empty the tears into tear sacs which are located under the skin on each side of the nose.

From the sacs, the tears are pumped by the blinking action of the lids, into tear ducts that go through the side bones of the nose into the back of the nose. Our nose runs whenever we cry because the tears flow from the eyes, down the tear ducts, and into the nose.

What Causes Overflow Tearing?

This condition is usually caused by a persistent membrane that blocks the lower end of the tear drainage canal inside the nose. Normally, this membrane stretches or pops open at or before birth. In many infants however, it is still closed at birth and the tear drainage system is clogged.

Are There Other Causes Of Overflow Tearing?

Very rarely, a baby may have congenital glaucoma. There are other signs and symptoms associated with this serious condition such as an enlarged eye, a clouded cornea, high pressure in the eye, light sensitivity, and infant irritability. Overflow tearing can also be caused by irritation of the eye from wind, pollen, smoke, and chemicals.

How Is Overflow Tearing Treated?

Initially, the ophthalmologist will recommend antibiotic eye drops or ointment to be used once or twice daily, along with pressure (or massage) over the tear sac.

The technique for applying pressure is to place a finger under the inner corner of the infants eye next to the nose, and roll the finger over the bony ridge while pressing down and in, against the bone of the side of the nose. This expresses mucus and tears from the sac. Following the pressure on the sac, an antibiotic should be placed inside 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 probing and irrigation.

How Is Probing Of The Tear Ducts Performed?

A thin, blunt metal wire is gently passed through the tear drainage system to open any obstruction. Fluid is then irrigated through the system into the nose to ensure that the pathway is open. Infants have no pain after the probing.

Some blood-staining of the tears or nasal secretion is common after probing. There may be discharge in the eye for up to a week and antibiotics may be prescribed. Obstruction can recur and repeated probing may be required.

If probings are not successful, plastic or silicone tubes can be placed in the drainage canals. This is a longer procedure than probing and requires general anesthesia. Rarely, further surgery is needed to bypass the blocked tear duct to 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 reobstruct the opening, requiring additional surgery. Chronic obstruction can lead to infections of the tear sac at any age.

Reference: American Academy of Ophthalmology