The commonest reason a baby's eye waters is that the tear duct has not opened at birth. This page covers the first twelve months: why the obstruction occurs, what parents notice, how lacrimal sac massage is performed and which pictures should not wait. Probing, tubes and surgery, which come in when watering persists beyond the first birthday, are a separate subject, gathered on the probing and surgical treatment in children page.
Tears enter the puncta at the inner corner of the eye, pass through the canaliculi into the lacrimal sac, and drain from there into the nose through the nasolacrimal duct. Even when production is normal, tears overflow if the drain is blocked.
Where the duct opens into the nose there is a thin membrane left from development in the womb, the valve of Hasner. In most babies it opens shortly after birth. When it does not, tears spill over the lid margin: the eye looks wet even when the baby is not crying, and crusting builds up overnight. About one in five newborns is affected, on one or both sides.
When both ends of the duct are closed, fluid collects in the sac and a tense, bluish swelling appears beside the bridge of the nose. This is a dacryocystocele: noticed in the first days of life and painless, but it tends to become infected, and a cyst inside the nose can make breathing difficult. It needs early assessment rather than watchful waiting.
Congenital duct obstruction is rightly the first diagnosis considered in a constantly watering baby, and usually the correct one. Even so, I recommend an eye examination for every such baby: other conditions produce the same picture and must not be missed.
When watering comes with marked light sensitivity, corneal haze, an eye that looks enlarged or forceful lid closure, the picture is different. These findings occur in congenital glaucoma and call for prompt assessment; to separate the two I measure corneal diameter and assess intraocular pressure. See child glaucoma for detail.
Lashes rubbing on the ocular surface also make a baby's eye water. If the lower lid turns in or the lid margin is structurally different, treatment goes another way; see structural disorders of the eyelid in children. A foreign body or a corneal abrasion gives the same appearance.
The confusion families meet most often is that watering is taken for conjunctivitis and antibiotic drops are used again and again. The drops reduce the discharge for a while, and the picture returns once they stop. That cycle is itself a distinguishing clue.
This is the main treatment of infancy. The aim is to raise the pressure inside the sac and help the membrane below it open. I show families the technique at the consultation, because the position and direction of the pressure determine the result.
About ten short, rhythmic downward strokes are applied in each session, two or three times a day. Tying it to a feed or a nappy change makes it easier to keep up. The frequency your doctor describes takes priority.
Wipe in one direction, from the inner corner outwards, with clean cotton moistened in cooled boiled water or saline, using separate cotton for each eye. Cologne, breast milk and herbal mixtures should not be put in the eye; they are not sterile and raise the risk of infection.
Antibiotic drops are used only when there is clear infection, on medical advice, for the period specified. They do not relieve the obstruction; they control the infection that develops in stagnant tears. Continuous use on the family's own initiative can harm the ocular surface.
This is the question I am asked most, and the answer reassures most families. The great majority of congenital obstructions open on their own within the first twelve months, a large share in the first six, with watering fading gradually. When symptoms are mild and there is no infection, continuing massage and cleaning while waiting is the right approach.
Once the first year is complete, spontaneous opening becomes markedly less likely and intervention comes onto the agenda. Probing, silicone intubation, balloon dilation and duct surgery after the first year are set out on the probing and surgical treatment in children page.
Stagnant tears sometimes inflame the sac. A red, warm, tender swelling appearing suddenly beside the bridge of the nose, with an unsettled baby and fever, suggests this picture, and the swelling can grow enough to close the lid. Acute dacryocystitis should be assessed the same day.
In the short video below I explain what a dacryocystocele is, the swelling seen at the inner corner in newborns.
For how the drainage system works see lacrimal system disorders, and for other childhood topics see pediatric eye diseases. The adult picture runs differently; see adult nasolacrimal duct obstruction and revisional surgery for failed nasolacrimal duct obstruction treatment.
Ayşe Dolar Bilge MD, FEBOphth.
Ophthalmologist, Oculoplastic Surgery
As an Ophthalmologist, Dr. Ayşe Dolar Bilge, I provide diagnosis and treatment services with my experienced team.
The most common reason is that the membrane where the tear duct opens into the nose (the valve of Hasner) has not opened after birth. Tears have nowhere to drain, so they spill over the lid margin: the eye looks wet even when the baby is not crying, and crusting builds up overnight. About one in five newborns is affected. Other conditions also cause watering, which is why I recommend an eye examination for every watering baby.
After washing your hands, place a clean fingertip beside the bridge of the nose, just below the inner corner of the lower lid, and apply gentle but firm pressure downwards, towards the nose. Repeat about ten times per session, two or three times a day. Circular rubbing does not produce the intended effect. I show families the technique at the consultation, because the position and direction of the pressure determine the result.
In babies, usually yes. Most congenital obstructions open on their own within the first twelve months, a large share of them in the first six. If symptoms are mild and there is no infection, waiting with massage and eye cleaning is appropriate. After the first year spontaneous opening becomes less likely and intervention comes onto the agenda.
No, I do not recommend it. Breast milk is not sterile, and instilling it on the ocular surface carries a risk of infection. The same applies to cologne, herbal mixtures and over-the-counter eye solutions. To clean a baby's eye, clean cotton moistened with cooled boiled water or saline is enough; use separate cotton for each eye and wipe from the inner corner outwards.
No. Antibiotic drops are used only when there is clear infection, on medical advice, and for the period specified. They do not relieve the obstruction; they reduce the discharge for a while and the picture returns once they are stopped. Continuous use on the family's own initiative can harm the ocular surface. The symptoms returning each time the drops finish is itself a clue that the duct is blocked.
If the swelling is red, warm and tender, particularly with fever, it may be an acute infection of the tear sac and should be assessed the same day. A bluish, painless swelling noticed at birth may be fluid collected within the sac (a dacryocystocele), which also needs early assessment rather than watchful waiting.
A painful, red and warm swelling beside the bridge of the nose, with fever and a markedly unsettled baby, suggests acute infection of the sac and should be assessed without delay. A bluish swelling noticed shortly after birth also needs early review. In addition, light sensitivity, haze of the cornea or an eye that looks enlarged require urgent assessment for congenital glaucoma.
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