CHRONIC TEARING IN INFANTS
As many as 50% of babies are born with an overabundance of tears and mucus. It is also quite common for babies' eyelashes to stick together after sleep. Either situation can lead to chronic infections of the eye.
Overflow tearing can be caused by a narrowing, or blockage of the nasal lacrimal system. In all people, tears are created by the lacrimal gland and drain from the eye via two little holes in the eyelid, the upper and lower puncta. They then enter a sac and travel down a canal known as the tear duct and drain into the nose and finally into the throat. This is why when you cry your nose gets stuffy and you can taste your tears. In many babies, there is a blockage somewhere in this system so that the tears and mucus normally made reach this blockage, can go no further, back up the canal and exit through the puncta, like a clogged drain.
Overflow tearing is usually caused by the presence of a persistent membrane that blocks the lower end of the canal, inside the nose. Normally this membrane pops open at or before birth. In 90% of cases, this membrane will indeed open by 6 months of age.
Very rarely, overflow tearing can be caused by congenital glaucoma. Dr. Kronwith will be sure to thoroughly examine your child to rule this out. Some signs of glaucoma are, in addition to tearing, light sensitivity, an enlarged eye, a clouded cornea and infant irritability. If these signs are present, your baby should be seen immediately! If they are not present, the doctor likes to see all babies who are tearing at around 3 months of age.
If tearing is due to a blocked tear duct, Dr. Kronwith takes a conservative approach since this condition can resolve spontaneously. He will teach you a method of massaging the tear canal to help in the resolution of the condition. After 6 months, he will offer you the option of what is known as a probing of the duct. In this procedure, a thin metal probe is inserted into the punctum and threaded down the canal in the hope of popping the persistent membrane. This procedure works in about 90% of cases. This probing is done in the hospital, in a special procedure room, using a very short acting sedative given intravenously. From the moment you enter the room to the moment you leave for home will be about 15 minutes. There are no side effects of this sedative such as the nausea and vomiting associated with general, inhalation anesthetics.
For those parents who would rather wait, the probing can be delayed until a year of age. There is some evidence that after a year, the success rate starts to decrease though the final word is still not in. However, because of this theory, the doctor prefers to probe initially no later than 12-15 months of age, and, as mentioned, will probe as early as 6 months of age if requested.
In those cases where probing is not successful, there are other alternatives that will be discussed with you.