|“My baby looks like she is crying all the time.”|
|Nasolacrimal duct obstruction|
|Other anatomic abnormalities of the lacrimal
|• Absent lacrimal puncta|
|• Lacrimal fistula|
|Nasolacrimal obstruction (by far most common)|
|Periocular crusting, worse in morning|
|Child otherwise fine,
does not appear bothered by problem|
|Other anatomic problems|
|Absent lacrimal puncta|
|Excess tearing only|
|Tears emanate from fistula tract between the
eye and the nose|
|Parents note in-turning of lower eyelid|
|Excess tearing, mucoid discharge|
|Child is light sensitive|
|One or both eyes larger than normal|
|Glassy or cloudy appearance to cornea|
|Tearing only, not crusting|
|Photophobia (light sensitivity)|
|Usually markedly decreased vision|
|Increased tear lakes, periocular crusts|
|Child usually otherwise normal|
|Conjunctiva white, no inflammation|
|Other anatomic abnormalities|
|Same except no ocular discharge|
|Excess tears (arise from fistula)|
|Same except mucoid discharge|
|Lower eyelashes turned inward against cornea (epiblepharon)|
|One or both eyes enlarged (buphthalmos)|
|Cloudy or glassy appearance to cornea|
|Clear tears only|
In case of a lacrimal obstruction, lacrimal massage and topical
antibiotics as needed are indicated. If no improvement occurs with
age, refer to an ophthalmologist.
If corneal problems or glaucoma are suspected, refer immediately
to an ophthalmologist.
Glaucoma should not be missed. Early treatment of glaucoma is critical
to optimizing vision. If a child with excess
tearing has corneal clouding or eye size asymmetry, immediate referral
to an ophthalmologist is indicated.
Excess tearing in infants is one of the most common eye problems
that pediatricians encounter. Approximately 6% of infants
have some symptoms of excess tearing. Most of these spontaneously
improve. Because this symptom is so common, however, it is possible
to overlook much rarer but potentially serious disorders that present
with the same clinical picture.
- 1. Nasolacrimal duct obstruction
(NLDO). This is by far the most common cause of excess tearing
in infants. It results from incomplete opening of the tear ducts,
with symptoms of overflow tearing (epiphora), periocular crusting,
or both (Figure 7–1). Most symptoms of NLDO resolve within
the first 1 to 2 months of life.
- 2. Other anatomic abnormalities of
the lacrimal system.
- a. Absent
lacrimal puncta. Much less frequently, infants are born with
absent or imperforate lacrimal puncta (the site on the eyelid where
the tears enter the lacrimal system) (Figure 7–2A and
B). These children present with overflow tearing only. Unlike most
children with NLDO, these patients do not get periocular crusts
or other symptoms of infection.
- b. ...