TEARING PROBLEMS IN INFANTS

INFORMATION FOR PATIENTS OF DR. S. KRAFT

The tear film in the eye is an important protective layer that keeps away infections and allows the eye to maintain a clear focus for vision.  The tear film continually replenishes itself. It washes across the front of the eye and enters the inner corner of the eye.  It passes into the tear sac which is located under the skin at the side of the nose.  The tears then pass downward through a vertical passage into the back of the nose.

Up to 20 percent of normal infants have blockages of one or both passages when they are born.  This leads to “overflow” tearing from the affected eye(s).  If the blockage is significant there may also be recurrent infections that cause pus to discharge from the eye(s).  The blockage is most commonly found at the lower end of the tear passage where it enters the nasal passages.

Up to 80 percent of the time a blocked tear duct will open on its own by the time the infant is 6 months old.  Of those that remain blocked after that time, most will open between ages 6 months and 1 year of age.

To try and open the tear passage, it is helpful to increase the fluid pressure within the tear sac by a technique known as MASSAGING.  The parent or caretaker massages the side of the nose firmly in a circular motion with an index finger.  This action in turn increases the fluid pressure within the tear passage and forces open its lower end.  Repeated daily massaging will often lead to a cure of the problem:

I recommend massaging the tear sac with a firm circular motion 20 TIMES EACH SITTING, with at least 4 SITTINGS PER DAY until the tear passage opens and the daily tearing stops.

If there is an infection, your doctor will prescribe antibiotic drops which are to be given 4 times per day for 7 to 10 day course.  DO NOT STOP THE DROPS EVEN IF THE PUS DISCHARGE STOPS BEFORE THEN.  It is helpful to give the antibiotic drops at the same sitting when you are massaging the tear sac.

First massage 10 times to force out any pus in the tear sac, then administer the antibiotic drops, and finally massage a further 10 times to force the drops into the tear passage.

If the passage does not eventually open on its own with massaging, or if there are recurrent infections, then a PROBING of the tear passage may be needed.  This is not usually attempted until the child is almost 1 year old as most blockages will clear by then.  This is a minor out patient procedure in hospital that lasts no more than 15 to 20 minutes and does not involve  surgery or stitching.  An anaesthetic is needed to sedate the child.  It is successful at relieving a blockage in 90 percent of cases.  Occasionally a second probing is required.

Following a probing your doctor will prescribe eye drops to put into the eye(s) for 5 to 7 days and will arrange a follow up appointment 1 to 2 weeks after the procedure.  Any crusting on the eyelids can be removed carefully with a cotton ball or gauze dipped into warm water.