Tearing in children – Epiphora
Excessive tearing in infants is a common reason for consultation in young children and is often associated with epiphora (increased tear production). While a source of concern for parents, excessive tearing and epiphora are rarely serious. However, this excessive tearing is frequently associated with recurrent conjunctivitis, which is tiring for both the child and the parents, who are forced to perform repeated irrigations and treatments. In most cases, excessive tearing in children resolves spontaneously before the age of one. If it persists, more invasive treatments may be considered.
What are lacrimation and epiphora?
Epiphora and excessive tearing are two closely related conditions. They result from either excessive tear production or impaired tear drainage.
In epiphora, the eye is bathed in tears, this means that the height of the tear film is too great on the edge of the eyelid.
When epiphora exceeds a certain height, or during blinking, the excess tear runs down the cheek, this is called lacrimation.
Is excessive tearing common in children?
Tearful tears are common in newborns and infants.
About one third of babies are born with chronic tearing and have large amounts of mucinous or dirty secretions during their first year of life.
Causes
Congenital obstruction of the nasolacrimal duct
Most problems with excessive tearing in infants and very young children are due to a congenital obstruction of the nasolacrimal drainage pathway.
The duct (tear drainage system) carries tears from the inner corner of the eyelid to the nasal cavities (into the nose).
In many infants, a persistent membrane blocks the lower end of the tear duct, just as it opens into the nose. This prevents proper drainage of tears.
In 95% of children, this congenital obstruction resolves spontaneously within the first year of life. If the obstruction does not resolve before the child's first birthday, intervention should be considered.
Complications of excessive tearing
When the tear ducts become blocked, the tear film stagnates and tears can run down the cheek. This blockage and runoff lead to three problems:
Irritation of the lower eyelid.
Recurrent conjunctivitis due to stagnation and infection of tears on the surface of the eye.
Dacryocystitis – Infection of the tear duct due to stagnation of tears in the duct.
Other causes of tearfulness in children
Excessive tearing is sometimes caused by misaligned eyelashes rubbing against the cornea (trichiasis). This phenomenon is more common in infants of Asian descent. It is caused by a fold of skin that curls the eyelashes towards the cornea.
It can also be caused by external irritants: wind, pollen, smoke or chemical exposure.
Severe tearing – Congenital glaucoma
Very rarely, excessive tearing in children can be caused by congenital glaucoma. Other symptoms are associated with this condition:
Bulging eyes
A cloudy cornea
High intraocular pressure
Abnormal sensitivity to light.
How is excessive tearing treated in infants?
Tearing in children does not require curative treatment during the first year of life, except in cases of repeated dacryocystitis.
Conjunctivitis is treated repeatedly and secretions are removed by eye washes.
Massages can be performed to help drain the tears.
After 1 year, if tearing persists (5% of children), minimally invasive surgical treatment may be undertaken.
Massages
Place a finger under the inner corner of your child's eye, near the nose, and slide the finger down along the bony ridge, applying gentle pressure.
This increases the pressure inside the tear sac and can help the valve to become permeable.
The gesture also helps to remove mucus and tears from the sac.
After applying pressure to the area of the sac, rinsing the secretions with physiological saline is recommended.
Lacrimal duct probing
A thin, rigid probe with soft edges is gently passed through the lacrimal punctum (entrance to the lacrimal canal), then down through the lacrimal sac, and into the nasolacrimal canal to the nose.
A slight popping sensation may be felt when the Hassner's valve (the obstructing membrane) is crossed. Physiological saline (sterile water) is then irrigated into the tear duct system to clear the blockage and ensure the passage remains open.
The catheterization is a minimally invasive and low-risk procedure. However, it is most often performed in the operating room, under general anesthesia.
After the procedure, the child does not feel pain, but it is common for their tears to be tinged with blood or for them to have a nosebleed. The watery eyes may also persist for a few weeks.
Complications from a simple catheterization are very rare – aspiration, bleeding and infection.
The success rate of probing is 90 to 95% when performed between the first and second year of life. However, lacrimal duct obstruction caused by probing is successfully treated up to the age of 5-6 years.
Silicone tubes
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If the tearing is not relieved after the first probing because the valve has become blocked again, a second probing may be performed. A flexible silicone tube is then left in place to keep the valve open for several weeks and prevent it from collapsing again.
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General anesthesia is necessary in this case. A loop of the tubing is visible in the inner corner of the eye but does not cause any problems.
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The silicone tube is fixed in the nose and allows tears to flow around the tube.
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The tube is left in place and removed in the office or operating room with brief anesthesia 6 to 12 months after insertion.
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The most common complication with silicone tubes is their extrusion, either spontaneously or because the child has pulled on them.
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If this happens, stick the tube that has moved onto your cheek or nose with a piece of tape and contact the surgeon.