Watery eyes in children (epiphora)
Watering eyes in children (both eyes) is common. The most common cause is congenital nasolacrimal duct obstruction (CNLDO), which represents a delay in the maturation of the nose and lacrimal system rather than a fundamental structural problem.
Babies with CNLDO often present with recurrent bacterial conjunctivitis. Their eye become red and sticky with a purulent discharge. Antibiotic drops almost always help this to get better more rapidly and as the tear duct opens the infections clear.
Most babies whose eyes water simply have a tear duct that is slightly narrow. In 90% of these infants the tear duct will widen by itself before they are 12 months old and the eyes will stop watering.
Conservative management
The non-surgical management of watering eyes in children requires that the child’s parents understand the natural history and are aware that they should avoid frequent and unnecessary topical antibiotics. These should be reserved for use in situations of active infection. Parents can also help to manage the discharge and keep the infection problems under control by wiping sticky eyelids and lashes with cold boiled water.
Lacrimal sac massage
Parents can also help by massaging the lacrimal sac below the medial canthal tendon with a little finger (provided the fingernail is nice and short!) This technique increases the pressure in the lacrimal system, helping to express fluid and mucous into the conjunctival fornix. Massage can help to reduce the incidence of conjunctivitis but more importantly, the pressure in the lacrimal passages produced by the massage may accelerate the opening of the obstruction in the nasolacrimal duct.
Surgical Management
If symptoms persist by the time a child is one year of age CNLDO can be cured in about 95% of cases by passing a probe along the passageways under a brief general anaesthetic.
Occasionally, this is performed earlier if the child has particularly troublesome symptoms. If the first probing fails it can be repeated. If repeat probing fails, the introduction of delicate silicone tubes into the duct and leaving them there for a few weeks while the lining of the duct heals is the next step.