Overflow tearing in infants is usually caused by a congenital narrowing, or stenosis, of the drainage system from the eye to the nose (the nasolacrimal duct). Poor drainage of tears can lead to chronic eye infections, usually resulting in a yellow or green discharge from the eye and crusting of the eyelashes. Approximately 5% of all infants are born with an overabundance of tears. Fortunately, the vast majority (greater than 95%) resolve spontaneously by 1 year of age.
Blockage of the tear drainage system is usually treated conservatively in the first year of life. Antibiotic drops are used to treat active infections. Massage over the inner corner of the eye (the location of the lacrimal sac) can encourage opening of the obstruction. This Crigler massage is performed by placing a finger under the inner corner of the infant’s eye next to the nose. The finger is then rolled over the bony ridge while pressing down and in against the bony side of the nose.
When overflow tearing persists beyond 11 months of age, the chances for spontaneous resolution are low. In these instances, a probing is performed to open the obstruction. In the operating room, a thin, blunt metal wire is gently passed through the tear drainage system. Infants experience no pain after the probing, but some blood-tinged tears or nasal secretions is common for 1-2 days. Probing takes only a few minutes and has a greater than 95% success rate. In older children and children in which a probing has not been successful, silicone tubes can be placed in the drainage canals. These tubes are left in place for 3 months and removed easily in the clinic.