Excessive tearing in an infant, known medically as epiphora, is a common occurrence. While seeing tears constantly spill onto a baby’s cheek can be worrisome, the underlying cause is typically harmless and temporary. This symptom usually indicates that the delicate tear drainage system is not functioning perfectly, often because it is still developing. Understanding the reasons for a baby’s watery eye helps distinguish between a simple developmental delay and a situation requiring medical attention.
The Most Common Culprit: Blocked Tear Ducts
The vast majority of persistent watery eyes in infants are due to congenital dacryostenosis, commonly known as a blocked tear duct. Tears are produced in the lacrimal gland, wash over the eye, and then drain through small openings (puncta) in the inner corner of the eyelids. These openings lead into the nasolacrimal duct, which travels down and empties into the nose.
In a newborn, the nasolacrimal duct is sometimes obstructed by a thin, undeveloped membrane near the nasal opening. If this membrane fails to open completely at birth, tears cannot drain into the nasal cavity. Instead, they back up and overflow onto the cheek. This condition affects approximately 6% of all newborns, making it the most frequent cause of excessive tearing.
Symptoms of a blocked tear duct typically appear a few weeks after birth, once infants begin producing more tears. Parents often notice clear, watery tears pooling in the corner of the eye, even when the baby is not crying. This tearing may be accompanied by a sticky, mucus-like discharge or crusting on the eyelashes and eyelids, particularly noticeable upon waking. Symptoms can worsen when the baby is exposed to cold weather or has a common cold, both of which increase tear production.
Other Reasons for Watering Eyes
While a blocked duct is the most likely cause, excessive tearing can also signal infection or irritation. Conjunctivitis, or pink eye, causes inflammation of the membrane covering the eye and inner eyelid. Bacterial conjunctivitis produces a thick, pus-like discharge, often yellow or greenish, which may cause eyelids to stick together after sleep. Viral conjunctivitis, often associated with a cold, typically produces a thinner, more watery discharge and may include general cold symptoms.
Environmental irritants like dust, smoke, or strong winds can trigger a reflex increase in tear production, leading to temporary watery eyes. Allergies can also cause tearing, but this is usually accompanied by intense itching and redness in both eyes simultaneously. A much rarer, but serious, cause is congenital glaucoma, which involves high pressure inside the eye. Signs of congenital glaucoma include extreme sensitivity to light, a hazy or cloudy appearance to the cornea, and unusual enlargement of the eye.
Simple Home Care and Management
For an uncomplicated blocked tear duct, specific home management techniques are often recommended to help the membrane open naturally. The most common technique is the nasolacrimal duct massage, sometimes called the Crigler massage, which aims to increase pressure on the duct to force the membrane to rupture. To perform the massage, place a clean finger on the outer side of the baby’s nose, near the inner corner of the eye. Apply gentle pressure, rolling the finger downward toward the cheekbone and nose using a firm, milking motion.
This downward stroke should be repeated three to five times, two to three times per day. The massage helps push fluid down the duct, increasing pressure against the obstruction. To manage sticky discharge, the eye should be cleaned frequently with a clean cloth or cotton ball soaked in warm water. Always wipe the eye gently from the inner corner toward the outer corner, using a fresh section of cloth for each wipe to avoid spreading irritation.
When to Consult a Pediatrician
While many blocked tear ducts resolve on their own, usually before the baby’s first birthday, certain signs require prompt medical evaluation. Parents should contact their pediatrician immediately if the baby develops symptoms of a serious infection, known as dacryocystitis. Warning signs include a fever, significant swelling, or intense redness near the inner corner of the eye. A hard, red, or tender lump appearing at the side of the nose, just below the inner eyelid, also signals a localized infection that needs attention.
A visit to the doctor is necessary if the discharge changes to a thick, yellow, or green pus-like consistency, or if the eye becomes painful. If excessive tearing persists past 9 to 12 months of age, or if the baby exhibits symptoms like light sensitivity or corneal cloudiness, an eye specialist should be consulted. For ducts that remain blocked past the first year, an ophthalmologist may recommend a minor procedure, such as nasolacrimal duct probing, to manually open the membrane.