Infant's watery eye may indicate blocked tear duct

Did you know babies make tears from the very start of life? They don’t make a ton of eyeball lubricating tears initially, but within even a few days, they are making plenty to keep the eye from getting excessively dry. For many newborns, this becomes abundantly clear as the tears begin to spill over the edge of the eye because the drainage system is clogged up.

This blockage or narrowing of the drainage system of the eye is commonly known as a blocked tear duct or dacryostenosis. We all make tears that need to drain out of our eye via a little duct at the corner of the inner aspect of the lower eyelid. If you pull your own lid down while looking in a mirror, you will see a small duct. It is through this tiny duct that the normal lubricating tears of the eyes drain into the nose. This is in part why your nose begins to run even before you shed a tear when you are starting to cry. In many infants, this duct is more narrow than it needs to be and as a result the normal lubricating tears pool in the eye, making it appear glassy or wet. At first this extra moisture is clear like tears would be, but as time passes, this little pool of tears provides a wonderful place for bacteria to grow. Just like a puddle right after a storm, the water is clear but after a day or two the puddle is murky due to bacterial growth. The same is true for the eye. These pooled tears provide the perfect medium for bacteria to grow. Within days, often a green or yellow goopy discharge has replaced the clear, watery tears.

Treating this goopy infection is quite easy with either eye drops or ointment, but because the underlying problem of the blocked or narrowed duct remains, this cycle of infection will repeat itself many times until the duct opens up. The process of the tear duct opening happens naturally over the course of several months with the vast majority of infants having no problems by about 6 months of age. For those infants whose blockage persists beyond that point, seeing an ophthalmologist to have the duct mechanically probed to widen it makes sense.

Some doctors have recommending massaging the side of the nose where the duct drains as a strategy to open the duct. In theory, by massaging and forcing through a larger volume of tears through the process, the duct will open up. Unfortunately, studies have failed to consistently show that this process makes much difference in the long run. The vast majority of these blocked ducts will open on their own, so treating the intermittent infections while awaiting nature’s resolution makes the most sense. If nature doesn’t do the job, then having the duct probed by the eye doctor makes the most sense.