THE WATERY EYE


Are tears constantly streaming out of your child’s eyes? This could be troublesome to you as a parent, as well as a misery in having to regularly wipe them away.

A watering eye is very, very common in children, especially in newborns and children under 1 year of age. It is also known as epiphora and is characterized by an overflow of tears onto the face.

Should you be worried as a mom? (or dad)
WHY WE HAVE TEARS
Tears are "beneficial":
  • Keeps the front surface Healthy
  • Prevent Infection
  • Promote Healing
  • Prevent possible Dryness
  • Maintain Clear Vision
Our tears are quite “beneficial” to our eyes. They not only express deepemotions such as happiness, or sadness but tears are extremely helpful in keeping the front surface of our eyes healthy. They provide nutrients, yes food, and oxygen to help prevent infection and even promote healing. They help prevent possible dryness and create a nice smooth surface of the front of the eye, which is very important for maintaining clear vision.



Unfortunately, too many tears can make it difficult to see!!An interesting fact is that the tear film actually consists of 2 layers. A watery aqueous layer which makes up 95% of the tear film and is produced by a little gland which sits just under the outer part of the eyebrow. And a lipid or fatty layer that is secreted by little glands in the eyelid called Meibomian glands. These little glands are the ones that create lumps or chalazions if they get blocked.
WHAT CAUSES A TEARY EYE?
Well, it can basically develop at any age. It can also affect only one eye or even both eyes and is more common in children younger than 12 months. Statistics show that 20% of all newborns will develop a teary eye in the first month of life.

But mom, the good news is that the majority will spontaneously resolve by themselves!

The two main causes of watery eye in your child are:
  • Failure of the drainage system (i.e. a blocked tear duct/s)
  • Excessive production of tears
TEAR DRAINAGE SYSTEM
Tears drain via the puncta – lacrimal punctum (little holes on the inner eyelids) into the canaliculi (little tubules). From here they enter a little sac called the nasolacrimal sacwhich sits between the nose and the eye. From here the tears then drain into the nose down the nasolacrimal sac

BLOCKED TEAR DUCTS
A blocked tear duct is most often due to an underdeveloped tear duct system as it enters the nose. The image of the tear drainage system will give you as a parent a better understanding of how this works in your child.


Blocked tear ducts are most commonly caused by a small persistent membrane called the valve of Hasner. This is a remnant of a membrane that was still present when the baby was developing inside the mother. It lies at the outlet of the nasolacrimal duct, just as the tear drainage system enters into the nose. The great news about all babies born with a blocked tear duct, is that 95% of blocked tear ducts will resolve on their own within the first year of life and nothing needs to be done surgically!!!

If the tear ducts are narrowed or blocked, the tears will not be able to drain away and will build up in the tear sac. This can lead to a constant sticky, gooey eye that is very concerning to most parents.

The majority of the time this is just a build up of the normal tear film secretions and can be wiped away on a regular basis with a soft cotton wool ball soaked in sterile water.

(Sterile water needs to be boiled, but make sure it is cooled before dipping the cotton wool into it.)

Motionless tears in the tear sac do however increase the risk of infection. It’s almost the same as still standing water in a stream. It gets dirty. So, if the "regular" discharge becomes plentiful or there is any redness or swelling in or around the eye, it is best to seek medical advice.

HOW DO I TREAT MY CHILD'S BLOCKED TEAR DUCT?
For the majority of cases it's about patiently waiting and letting the natural growth of the baby's face take place. Your doctor may recommend something called tear duct massage on a regular basis to try and help unblock the system.

If by the age of 1 the eye is still tearing, a small procedure called a syringing and probing is recommended. This can be done in the rooms in older kids and adults but for young children a general anaesthetic, is required. A small metal probe is used to widen the system and unblock the membrane.

A small number of children may have a more complex situation such as a complicated type of blockage and more involved treatment may be necessary. This might involve inserting a silicone tube into the system to keep it patent (open) for several months or surgically creating a new drainage system.

Other less common causes of tear duct blockage in children include scarring due to chronic infections, inflammation, trauma, radiation etc. or mechanical obstruction due to nasal foreign bodies or mucoceles.
TEAR DUCT MASSAGE
Place a clean thumb or forefinger on the skin just above the tear sac, the area that lies between the eye and the nose. You then stroke downward applying pressure. The idea behind this is to try get some of the fluid or pus that has collected squeezed downward and cause the membrane to open. I recommend to my patients parents that they make it a "game" and every time they pick up the baby the do it once or twice which will add up to lots of times over the entire day.
OVER-PRODUCTION OF TEARS
Your child’s eyes may be irritated, which may produce more tears than normal as the body tries to rinse the irritant away.

The following irritants can cause the over-production of tears:
  • Chemicals such as fumes and even onions
  • Infective conjunctivitis
  • Allergic conjunctivitis
  • An injury to the eye, such as a scratch or a bit of grit (tiny pebble or piece of dirt
  • Trichiasis, where the eyelashes grow inward
  • Ectropion, when the lower eyelid turns outward
The main treatment for overproduction of tears is to address the cause and tailor the treatment accordingly. This might include removing the irritant or treating the infection or allergy.



SERIOUS CAUSES OF A WATERY EYE
It’s always safe to rather have your child’s eyes examined as some of the more serious causes of watery eye can affect your child’s vision.

These serious conditions include:
  • Keratitis, an infection of the front of the eye
  • Corneal ulcer, an open sore that forms on the eye
  • Congenital glaucoma (high pressure in the eye)
These conditions need prompt treatment by an eye care professional to help prevent vision loss. Pediatric ophthalmologists understand the unique needs of children and it’s always a good idea to consider visiting one for your child.
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