Overflow Tearing

What Is Overflow Tearing?

Overflow tearing, a common birth condition in infants, occurs due to a narrowing or blocking of the canaliculus, a part of the nasal lacrimal drainage system. The blocked system can spontaneously open within a few months of birth, or it can be surgically opened. Overflow tearing can also occur when the child's eyelashes stick together after sleep, a situation that can cause one or both eyes to become chronically infected; or when environmental elements irritate the eye.

Symptoms

  • Excessive tearing

The symptom described above may not necessarily mean that you have overflow tearing. However, if you experience this symptom, contact your eye doctor for a complete exam.

Causes

Overflow tearing occurs when a membrane covering the tear duct inside the nose fails to open at or before birth, thus clogging the nasal lacrimal draining system.

Risk Factors

This is a very common birth condition.

Tests and Diagnosis

This condition is often diagnosed by a thorough history and physical examination.  A fluorescein dye may be instilled by a drop into the eye to see how well the tears drain.

Treatment and Drugs

Medication

Initially, your doctor may recommend antibiotic eye drops or ointment used once or twice daily, along with pressure (or massage) over the tear sac. To apply this pressure, the adult caregiver places a finger under the inner corner of the eye next to the nose, and rolls over the bony ridge, pressing down and in. After applying this pressure on the tear sac, the antibiotic can be placed in the eye.

Surgery

If the tearing persists, it may be necessary for the ophthalmologist to open the tear ducts by probing and irrigation.

A thin, blunt metal wire is gently passed through the nasal lacrimal drainage system to open any obstruction, and fluid is then irrigated through the system. Infants experience no pain after the probing, but some blood-tinged tears or nasal secretion is common. A discharge from the eye may be present for up to a week and antibiotics may be prescribed. Obstruction can recur, and if so, a repeated probing may be needed. If probing is not successful, plastic or silicone tubes can be placed into the drainage canals. This is a longer procedure than probing and requires a general anesthesia.

As with any surgical procedure, infection or bleeding can occur, or scarring can re-obstruct the opening, and require additional surgery. 

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Reviewed by Christopher Gappy, M.D.