Why does your baby have watering eyes, and what to do about it?
Watering eyes or epiphora is when the tears are persistent or excessive from a narrow or blocked tear duct. However, watering eyes can be caused by many factors. For instance, in a baby or infant, they are most commonly as a result of a congenital blocked tear duct. The tear ducts do not produce the tears, but they carry away the tears similar to the way a storm drain carries away rainwater.
Tears normally drain into your nose through tiny openings called the puncta at the inner corners of the eyelids near the nose, and in babies, the tear duct may not be fully open and functioning for the few months of life, so this is usually what causes a baby’s watering eyes.
Watering eyes in infants often settle all by itself by the age of 1 year. It is estimated that over 90% of babies with congenital nasolacrimal duct obstruction (CNLDO) spontaneously open the lower end of their duct into the nose as they grow and it represents just a delayed physiological opening of the lower end of the tear duct.
As a parent, you can help by keeping the eyelids clean if they should get matted and sometimes there is a large sac which gets filled up with tears which can then become a bit mucousy or even infected, so putting pressure on the sac to help to empty it of stagnant tears.
You have to know where the sac is, so if you have a look at your baby’s eye, and you go towards the corner of the eye at the nose and then just below the line between the outer corner and the inner corner of the eye. You put your little finger there and very gently press inwards and backwards, and that is where the sac is.
You probably will not be aware that you are pressing on the sac, but indeed it is there, and that hydrostatic pressure may even help open up the tear duct down to the lower end, as well as pushing out any stagnant tears that are stuck there. This can quickly be done on each side but you must have a short fingernail, and you used your smallest little finger to do this. There is a lot of social pressure on parents whose children have congenital nasolacrimal duct obstruction (CNLDO) and watering or sticking or matted eyes mainly when they go to a nursery school.
You have to let the teachers and everybody know that your child does not have an infection, they cannot spread it to another child and that it merely is the delayed opening of their tear duct. As I have said above, 90% of congenitally blocked ducts will be better by the age of 1 without any intervention. If intervention is required, this is done by either the paediatric ophthalmologist or the oculoplastic lacrimal ophthalmologist. In the UK, we tend to do this quite late roundabout the age one under a short general anaesthetic as a day case, whereas in the US they tend to treat the child at a much younger age and do a probing in the office.
I have never liked the idea of probing in the office under wrapping and also knowing that it is going to resolve most likely by the age of 1, I prefer to delay.
Many UK parents do not want their children to have a general anaesthetic, even with a paediatric anaesthetist, and so delaying helps them as well because they then know that between the ages of 1 year and 18 months’ that if it has not cleared up, then it is a very good idea to let me do a simple syringing and probing under a short general anaesthetic.
I do use a nasal endoscope to monitor my syringing and probing, particularly as child gets older where there may be a more complex pathology, and if the child has already had a syringing and probing done by another doctor and this is their second or even third one, then I do need to make sure there is no little cyst lying inside the nose that needs to be marsupialised.
Very often infants have quite heavy breathing and snoring, and this indicates that they have got a wide duct with a little cyst under the nose that may be a bit slower to open and require assistance endonasally as a small surgical procedure. If your child has watering eyes and they are under the age of 1, you should wait until they are about aged 1 and then seek help through your GP of your local paediatric or oculoplastic ophthalmologist.
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