Epiphora is the medical term for the overflow of tears onto the cheek, a common concern for parents during a baby’s first year. Although alarming, the causes are usually minor and manageable, often resolving without complex intervention. The issue typically arises because the tear drainage system is still developing or due to external factors irritating the eye’s surface.
Blocked Tear Ducts
The most frequent cause of persistent watery eyes in infants is dacryostenosis, or a blocked tear duct. This structural issue occurs because the nasolacrimal duct, the channel that drains tears from the eye into the nose, has not fully opened at birth.
The blockage is typically caused by the Valve of Hasner, a thin membrane that remains closed at the lower end of the duct. This prevents the normal flow of tears, causing them to back up and spill over the lower eyelid. Symptoms usually include a clear, watery discharge, often accompanied by crusting or mattering, especially after the baby wakes up. Importantly, this condition rarely causes redness in the white part of the eye, which helps differentiate it from an infection.
Since this condition often resolves naturally, conservative management is the first approach during the first year of life. Approximately 90% of cases spontaneously clear by the time the child reaches 12 months of age. Parents can support this process by performing the Crigler massage to help open the membrane.
This technique involves applying firm but gentle pressure to the lacrimal sac area, located at the inner corner of the eye next to the bridge of the nose. Hands should be thoroughly washed before performing the massage to prevent introducing bacteria. Place a clean finger on the inner corner of the eye and roll it firmly downward toward the side of the nose. This action creates hydrostatic pressure, helping to open the obstruction. Repeating this motion five to ten times, several times a day, is recommended.
Infections and Environmental Irritants
Infections, collectively known as conjunctivitis or “pink eye,” are another common cause of watery eyes, presenting different symptoms than a simple blockage. Viral conjunctivitis, often accompanying a common cold, typically causes a thin, watery discharge. Bacterial conjunctivitis generally produces a thicker, pus-like discharge that is yellow or green and causes the eyelids to stick together.
A particularly urgent form of infection is ophthalmia neonatorum, which occurs in the first month of life and is often acquired during passage through the birth canal. If the discharge is profuse and rapidly worsening, immediate medical attention is required to prevent serious complications. Chlamydial infections are also common in this age group, typically presenting with a persistent mucopurulent discharge.
Watery eyes can also be a reflex defense mechanism against external factors that irritate the sensitive surface of the eye. Environmental irritants such as dust, smoke, pet dander, or strong wind can trigger an excessive production of reflex tears to flush out the offending substance. This sudden increase in tear volume temporarily overwhelms the normal drainage system, leading to overflow, which also occurs if soap or shampoo residue enters the eye during bathing.
Warning Signs and Seeking Professional Help
While most instances of watery eyes are benign, certain symptoms indicate a need for prompt medical evaluation. Parents should contact their pediatrician immediately if the watery eye is accompanied by a fever, which can signal a systemic infection. Extreme sensitivity to light, known as photophobia, is another concerning sign that requires urgent attention.
Signs of severe local infection, such as significant swelling of the eyelid or pronounced redness and tenderness between the inner corner of the eye and the nose, also warrant an immediate visit. These symptoms can suggest a deeper infection of the tear sac (dacryocystitis) or the surrounding tissue. Any changes to the clear part of the eye, like cloudiness, or a sudden change in the baby’s vision should also be considered an emergency.
When investigating the cause of persistent tearing, a doctor may perform a Fluorescein Dye Disappearance Test. This involves placing a small amount of orange dye into the eye and observing how quickly it drains, which helps confirm if the drainage system is obstructed. If a blocked tear duct does not resolve with massage by 12 months, the doctor may discuss nasolacrimal duct probing. This simple outpatient procedure involves gently inserting a thin wire into the duct to open the membrane and restore normal tear flow.