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OVERFLOW TEARING AND CHRONIC EYE INFECTIONS IN INFANTS

What is Overflow Tearing?

Overflow tearing is a common condition in infants and babies effecting approximately one-third of all infants.

How Do Tears Drain From the Eye?

Tears drain from the eyes through two small openings called the upper and lower punctum which are located along the upper and lower eyelids near the nose. They then flow through the canaliculus into the lacrimal sac located under the skin on the side of the nose.

From the sac, the tears are pumped by the blinking action of the lids into the tear duct. These ducts go through the side bones of the nose and empty the tears into the back of the nose. That's why your nose runs every time you cry.

What Causes Overflow Tearing?

Overflow tearing is usually caused by the presence of a persistent membrane that blocks the lower end of the tear duct inside the nose. Normally this membrane stretches or pops open at or before birth. In many infants, however, it is still closed at birth clogging the tear drainage system. The blockage tends to open spontaneously in a few months as the infant grows. The same blockages cause recurrent infections in the tear duct.

Tearing in Infants

When is the best time to treat overflow watering in infants?
In one recent large study, it was shown that of those who have watery eyes at:
· 6 months of age - 75% will get better
· 10 months - 23% " "
· 11 months - 5% " "
· 12 months - very few "

Recommendations

1. Consider probing if at 10-11 months the child still has a watery eye because very few will spontaneously improve.
2. Whilst you are waiting:
· Use antibiotics only if the eyeball gets red or if a swab test that is sent to the laboratory shows that there are germs present
· Massage of the lacrimal sac may help but it is difficult and may be painful to do adequately. The doctor will demonstrate this to you.
· Clean the lids with cool boiled water. "Lid Care" are little eye wipes that you can buy from the Chemist to help keep the lids and lashes clean.
3. Delaying treatment beyond the second birthday does reduce long term chances a bit.

How is Probing of the Tear Duct Performed?

A thin, blunt metal wire is gently passed through the tear drainage system to open any obstruction. General anaesthesia is used. Fluid is then irrigated through the system into the nose to ensure that the pathway is open. There are no scars or stitches. Infants experience no pain after the probing but some blood-staining of the tears or nasal secretion is common and a discharge from the eye may be present for up to a week. Antibiotics may be prescribed.

Probing turns out to be inadequate in less than 10% of 1 year olds, and about 30-40% of 3-5 year olds. If probings are not successful, plastic or silicone tubes can be placed in the drainage canals. This is a longer procedure than probing. Occasionally, further surgery is needed to bypass the blocked tear duct and create a new opening through the bone into the nose.

What Complications Can Occur With Treatment?

As with any surgical procedure, there is the possibility of infection or bleeding. Scarring can re-obstruct the opening, requiring additional surgery. Chronic obstruction can lead to infections of the tear sac at any age.

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