Overflowing Tearing and Chronic Eye Infections in Infants

Abnormal or overflow eye tearing is a common condition in infants. In fact, approximately one-third of all newborns have excessive tears and mucus, 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 in the tear drainage system and spill over the eyelid onto the cheek.  They can also become infected which can lead to development of conjunctivitis, commonly known as “pink eye”.  You should contact your primary care physician, pediatrician or ophthalmologist if the discharge becomes thicker or changes color from white to yellow or green, or the white of the eye becomes red.

How do tears drain from the eye?

Tears are produced to keep your eyes moist.  As the 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 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. 

Are there other causes of tearing?

A very rare condition called congenital glaucoma can also cause excessive tearing.  With congenital glaucoma, other signs and symptoms with accompany tearing, such as an enlarged eye, a cloudy cornea, high eye pressure, light sensitivity and eye irritation. 

Tearing can also be caused by wind, smoke, allergies or other environmental irritants.  Rarely, the tear drainage system fails to develop normally.  An eye examination will identify the exact cause of the tearing. 

How is overflow tearing treated?

Your doctor may recommend:

• Applying antibiotic eye drops or ointment to the eye once or twice daily to fight infection;
• Cleaning the eyelids with warm water;
• Applying pressure (or massage) over the lacrimal sac.

To apply pressure place your finger under the inner corner of the infant’s eye next to the nose, and roll your finger over the bridge while pressing down and against the side of the nose.  This movement helps clear tears and mucus out of the sac.

The blocked tear duct often spontaneously opens within six to 12 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.

How is probing of the tear duct performed?

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 performed in an outpatient setting under local or general anesthesia.  It causes little or no pain, but tears may be stained briefly with blood or a nosebleed may occur.  An antibiotic or ointment may be prescribed. 

Are any risks involved with probing?

As with any surgical procedure, complications can occur, including:

• Infection;
• Bleeding;
• Re-obstruction of the tear duct.

Re-obstruction of the tear duct may require another probe or additional surgery.

Courtesy of the American Academy of Ophthalmology.  Reprinted with permission of the American Academy of Ophthalmology.  Copyright protected.  All rights reserved.  Users of this website may reproduce one (1) copy of this for their own personal, noncommercial use.  All Internet, web or electronic posting or transmission is not permitted.