Tearing in Children
(InSIGHT Newsletter Volume II Issue I)
Tearing problems are common among infants and newborn babies. Approximately one-third of all infants are born with an over abundance of tears and mucus.
Most excessive tearing problems in infants and very young children are congenital. The nasolacrimal outflow pathway has not fully opened due to the presence of a persistant membrane that blocks the lower end of the tear duct. inside the nose. Normally, this membrane stretches or pops open at or before birth. In many infants, however, it is still closed at 6 months causing a backup of the tear drainage system. The blockage may open spontaneously in a few months time as the infant grows. If it does not open by 10 months, intervention is required.
When the passage is blocked, a stagnation of tear flow occurs and is commonly associated with tears running down the cheek and discharge along the lid margin or on the eyelid skin. With time, the delicate lid skin can become red and irritated.
Other causes of tearing in children?
Very rarely, tearing in children can be caused by congenital glaucoma. There are other signs and symptoms associated with this serious condition such as an enlarged eye, a cloudy cornea, high pressure in the eye, light sensitivity and irritation. Tearing can occasionally be due to the eyelashes rubbing on the cornea. This is more common in Oriental infants and is due to a fold of skin rolling the lashes toward the cornea. Tearing can also be caused by wind, pollen, smoke or chemical eye irritation.
How is tearing in infants treated?
Initially, antibiotic eye drops or ointment used once or twice daily, along with pressure (massage) over the tear sac, is be recommended.
Massage Technique:
To apply pressure, place a finger under the inner corner of the infant’s eye next to the nose, and role the finger over the boney ridge while pressing down and, in against the boney side of the nose. This increases the pressure inside the tear sac and may also express mucus and tears from the sac. Following pressure on the sac, antibiotic is placed on the eye.
Most tear duct blockages in infants disappear by 6 months of age. If the tearing persists beyond 10 months of age, it may be necessary for the ophthalmologist to open the tear ducts by probing and irrigation.
How is probing of the tear ducts performed?
A thin, blunt metal probe is carefully passed through the canalicular and nasolacrimal sac to pop the membrane causing the obstruction. Fluid is then irrigated through the system into the nose to ensure that the passageway is open. Probing may be done in a clinic minor procedure room under local anesthetic, or in a hospital outpatient setting with a general anesthetic. Infants do not experience pain after the probing but some blood staining of tears or nasal secretion is common. Discharge from the eye may be present for up to a week. Antibiotic drops or ointment are used following the probing for about 1 week.
If the probing is done by 13 months of age, there is a 97% success rate. The success rate decreases after this point to 50% by the age of 2 years.
If the tearing is not relieved, a second attempt at probing can be tried. During the re-probe, silicone tubes can be put into the nasolacrimal system and left in place for several months. A general anesthetic is required to put the silicone tubes in. These tubes will keep the nasolacrimal passageway open while the infant’s tissues heal. The tube can be removed in the office 6 to 12 months later, leaving the tear passage open.
It is very rare that silicone tubes are not successful in relieving the tearing. In these situations, dacryocystorhinostomy surgery is required to open the system. A small skin incision is made along the nasolacrimal crest and one dissects down to the nasolacrimal sac. The sac is opened and anastomosed with the nasal mucosa. Silicone stents are also put in to help keep the tear passageway open. In these rare instances where a dacryocystorhinostomy is required, it is generally best to wait until the child is age 4 or 5 when the nose has grown to a sufficent size that surgery can be done without much difficulty.
What complications can occur with treatment?
With a simple probe, complications are very few. Occasionally, there is a little bleeding from the nose for a day or so. In the event of an unsuccessful probing, the child continues to tear. If a probing with placement of a silicone tube has been done, the tubing will be seen in the inner corner of the eye (medial canthus). If the child pulls the tube out, it will be quite obvious. In this situation, the tube needs to be completely removed to prevent eye irritation. If dacryocystorhinostomy surgery is required there is a possibility that infection or bleeding can occur but this is extremely uncommon. The scarring with the skin incision is generally mild and not noticeable after several months of healing. However, a noticeable scar can occasionally occur and may require revision. Scarring on the nasal mucosa side can re-obstruct the opening created, requiring additional surgery.
If you have any questions regarding the topics of this newsletter, or requests for future topics of InSight, please contact Dr. David R. Jordan office by telephone at (613) 563-3800.
