Approximately one-third of all newborns have excessive tearing. It occurs when a membrane (a skin like tissue) in the nose fails to open before birth, blocking part of the tear drainage system. If tears do not drain properly, they can collect inside the tear drainage system and spill over the eyelid onto the cheek. Rarely, the tear duct itself may become infected leading to a serious infection called dacryocystitis. If the skin of the inner portion of the eye becomes red and swollen and the child is having difficulty opening the eye, you should contact your ophthalmologist or primary care physician immediately as this condition requires emergent treatment with antibiotics.
Tears are produced to keep your eyes moist. As new tears are produced old tears drain from the eye through two small holes called the upper and lower punctum, located at the corner of your upper and lower eyelids near the nose. The tears then move through a passage called the canaliculus and into the lacrimal sac. From the sac, the tears drop down the tear duct (called the nasolacrimal duct), which drains into the back of your nose and throat. That is why your nose runs when you cry. In infants with overflow tearing, the membrane blocking the tear duct prevents tears from draining into the back of the nose and throat.
Tearing can also be caused by wind, smoke or allergies, or other environmental irritants. A very rare condition called congenital glaucoma can also cause excessive tearing. With congenital glaucoma other signs and symptoms will accompany tearing, such as an enlarged eye, a cloudy cornea, high eye pressure, light sensitivity and eye irritation.
Treatment of Blocked Tear Ducts
Blocked tear ducts can initially be treated by applying massage over the lacrimal sac, applying antibiotic eyedrops or ointment to the eye, and cleaning the eyelids with warm water.. To massage the tear ducts, place your finger under the inner corner of the infant’s eye next to the nose, and roll your finger over the bony ridge while pressing down and in against the bony side of the nose. This movement helps squeeze tears and mucus out of the sac.
The blocked tear duct often spontaneously opens within six to twelve months after birth. If overflow tearing persists, it may be necessary for your ophthalmologist to open the obstruction surgically by passing a probe through the tear duct.
Tear Duct Surgery
Dr. Dorfman and Dr. Cardone perform tear duct surgery as an outpatient surgical procedure. Surgery is usually performed at the approximate age of 1 years old after all conservative measure such as massage and antibiotic drops fail to resolve the condition.
Under sedation, a thin, metal probe is gently inserted through the tear drainage system to open the obstruction. The drainage system is then flushed with fluid to make sure the pathway is open. The procedure is usually completed in a matter of minutes.
Your child should soon be able to resume normal activities upon discharge from the surgical center. Clear liquids in small amounts are advised for the first few hours following surgery. As soon as the effects of the anesthesia have subsided, a normal diet may be resumed. You may bathe the child and the child may resume all usual activities the day after surgery. Swimming however, should be avoided for 2 weeks.
Following the surgery, your child will be on an antibiotic drop twice daily. Parents may see some blood tinged tears, or nasal discharge. Tearing may persist for a time after the procedure due to normal post-operative swelling. All these should resolve within a short time after surgery. Your child will return to see Dr. Dorfman or Dr. Cardone 1-2 weeks following the procedure.
In a small percentage of patients the tearing may persist despite the surgery. In these cases an additional probing procedure is required, often with placement of tubes within the tear drainage system to stent the tear ducts open.