Condition: Watering eyes (tearing children)2019-04-08T11:53:32+00:00

Watering eyes (tearing children) Overview

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There are different treatment options available for this condition and the most common ones are listed below:

  • Lacrimal sac massage

  • Syringing and Probing

  • Congenital dacryocele or congenital lacrimal sac mucocele management

  • Failed probing

Learn more about treatment options

Watering eyes (tearing children)

What are watering eyes (tearing children)?

One of the most common causes of watering eye in children is congenital nasolacrimal duct obstruction (CNLDO), which signifies a delay in the maturing of the nose and lacrimal system. Other causes of epiphora include congenital atresias and some craniofacial disorders.

At birth, 50% of nasolacrimal ducts are still not patent. Spontaneous perforation occurs rapidly in the first three to four weeks, meaning that only a few infants have symptomatic epiphora and/or stickiness after birth. Up to 96% of these cases resolve in the first year without intervention, a further 60% resolving in the second year, after which organic resolution continues more slowly.

Sufferers can therefore present with watering eyes during the first days of life, which can cause chronic conjunctival infection, mucous discharge, eyelid dermatitis, or even acute infections in the lacrimal sac known as acute dacryocystitis.


Conservative management of watering eyes in children requires the parents to understand the natural history of epiphora. They also need to be aware that they should avoid frequent and unnecessary topical antibiotics, except in the case of conjunctivitis. They should also know to wipe sticky eyelids and lashes with cold boiled water.

Lacrimal sac massage

The parent can massage the sac below the medial canthal tendon with a little finger, provided the nail is short. This increases the pressure in the lacrimal system, helping to express fluid and mucous into the conjunctival fornix. Massage may also accelerate opening of the lower end of the nasolacrimal duct.

Syringing and Probing

Syringing and probing are both under general anaesthesia with a laryngeal mask, following a comprehensive examination of the eyelids and puncta. The procedure can be carried out in the children older than ten to twelve months, in which symptoms continue despite the conservative management, unless there is a congenital dacryocele or acute dacryocystitis.

The punctum is dilated, allowing for insertion of a lacrimal cannula and syringe. The nasolacrimal duct is then investigated using probes of a different size. After this point, the membrane is perforated to allow entrance into the nose. A ‘pop’ might be felt but there is usually minimal or no bleeding during this procedure. Clinica London favours endoscopic endonasal monitoring to assess the position of the probe.

Postoperatively, topical steroid-antibiotic drops are used for one to three weeks, depending on the severity of the CNLDO. The patient is then reviewed in clinic in six weeks.

Congenital dacryocele or congenital lacrimal sac mucocele management

Congenital dacryocele is an uncommon neonatal swelling of the lacrimal sac which can become inflamed with acute dacryocystitis leaving the child febrile and ill. It is typically a tense, bluish swelling present at birth or within one to four weeks. Approximately 25% of sufferers have bilateral dacryoceles.

In cases of a quiet dacryocele, massage and warm compresses can be tried first. Congenital dacryocele however is the exception to probing and syringing at one year old as, in these cases, probing is preferable at less than six weeks. In cases of acute dacryocystitis, intravenous antibiotics are administered five to seven days before probing.

Failed probing

If endoscopic endonasal monitoring of syringing and probing fails, the procedure is repeated with silicone intubation. If intubation fails or if the case is complex, a DCR is considered. A similar surgical technique is employed in both adults and child cases, the Dacryocystorhinostomy (DCR) being either external or endoscopic. It is however preferable to wait until the child is aged two to four years before performing this operation.

Video: How do you treat watery eyes?

Examination of Watering eyes (tearing children)

Watering eye in children requires a specialised examination by a paediatric lacrimal surgery specialist in order to exclude absent puncta or canaliculi, as well as to identify mucocele, dacryocele and craniofacial disorders.

Specialised examinations can be carried out, so as to identify the tear meniscus and a test involving blue light and a special dye is done.


Here’s what they say

“Dr. Jane Olver was fantastic! She was so caring and sweet and it was clear that she knew what she was doing – very professional! I am absolutely over the moon with my results now!”

Toni C.

“Jane Olver is your woman – I wish I had found her at the start. I will be forever grateful for her care and expertise.”

Nancy W.

“Just wanted to thank you for your exceptional assistance with my eye condition. I was so worried but you really helped me feel at ease.”

David T.

“I felt much better after speaking to you and being reassured. I am much calmer and actually got some sleep last night.”

Catherine M.
“I was deeply impressed by the politeness and empathy shown to me. I found the surgery very peaceful and beautifully decorated and I hope to see Jane again soon.”
Jeffrey W.
“I highly recommend Jane Olver. The whole experience was calm and highly professional.”
Lorraine M.
“I am writing to you to say thank you to you, Cloe and Jane for taking care of me this week. You were all really lovely and professional and I am very grateful. Big cheer for The Clinica London Team.”
Rick A.
“Many thanks for taking care of my ptosis surgery today. I am now back home and resting but wanted to send a quick note to thank you for taking such good care of me.”
“The treatment was a great success; within 24 hours of starting the treatment the pain and swelling subsided and as a result, I was able to enjoy a great holiday in Argentina.”
“Thank you, my eye is recovering brilliantly (you almost can’t see I had it). Jane was amazing, please pass on a huge thank you.”

“What I loved most was her willingness to take my knowledge of my disease and experience into consideration. I am very impressed and feel lucky to be in her care.”
Fiona M.
“Dr. Crawley is always in such a good mood and always does her utmost to help. Best doctor I have ever seen!”
Matthew K.
“Dr. Crawley has a wonderful manner, is clearly knowledgeable and is an asset to the hospital.”
Lisa A.
“It was a pleasure to be there, the premises are excellent and the professionalism and care that was extended to me were equally excellent. I can’t fault any part of the process whatsoever and am pleased that the procedure seems to have been successful.”
Rob Swallow
“Thank you for your help during the year.”
Julia S.
“Just a quick note for saying thanks for looking after my Mum so wonderfully as she was very worried about the appointment and you really made such a big difference to the experience.”
Sven K.

“Thank you very much for seeing me yesterday, you were marvellous and a pride to the NHS.”

Mariah P.
“I was treated with great courtesy and kindness, and everything was explained to me in layman’s terms so I could fully understand my condition. I was immensely impressed.”
“Many thanks to Mr Khan. His prompt diagnosis and explanation was very reassuring indeed.”
Heather M.
“Dr Khan and Ingrid both put me at ease, talked me through the procedure, the aftercare, gave general tips/advice for maintaining a healthy/clean eye and were really friendly, whilst being professional throughout.”

“Just keep up the good work Dr. Khan. My wife, who accompanied me, and I were both very impressed by the care and consideration shown by the whole team when I had surgery. The care of this team has made it a wonderful experience for me.”
David S.
“Ever since my first consultation with you, the caring dedication and understanding I have received from you has been priceless. Thank you with all my heart. Wishing you a healthy and happy future.”
Doreen S.
“We left with a much greater understanding of the issues involved with genetic testing. It was also very helpful and reassuring to see Dr. Amar again and be introduced to Jonathan the genetic counselor.”
Rachael S.
“On behalf of my mother as well as myself, I would like to thank you for the consultation we had with you last Friday regarding my Usher Type 2/ RP condition. The knowledge and advice you shared with us was much appreciated.”
Chris B.
“Your caring attitude and honest approach to help relieve my problem and find the best solution is overwhelming. And it is with this in mind we would like to express our sincere thanks for everything you have done for me.”
Maurice K.

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