What is the treatment for a 1-month-old baby with watering from the eye?

Treatment for a 1-Month-Old Baby with Watering from the Eye

The most appropriate treatment for a 1-month-old baby with watering from the eye is conservative management with observation and nasolacrimal massage, as nasolacrimal duct obstruction is the most common cause and spontaneously resolves in approximately 90% of cases by 6 months of age. 1

Diagnosis

• Watering from the eye in a 1-month-old infant is most commonly due to nasolacrimal duct obstruction, which presents with persistent tearing and sometimes mucoid discharge 1
• Other possible causes to consider include conjunctivitis, congenital eyelid abnormalities, chemical irritation, trauma, occult foreign body, and congenital glaucoma 1
• Careful examination should assess for:
  • Discharge characteristics (mucoid, purulent, watery) 2
  • Eyelid abnormalities or swelling 2
  • Conjunctival inflammation or reaction 2
  • Presence of bluish swelling over the nasolacrimal sac (suggesting dacryocystocele) 1

Treatment Algorithm

For Nasolacrimal Duct Obstruction (Most Common)

• First-line: Conservative management with observation and nasolacrimal massage 1

  • Parents should be instructed to perform gentle massage over the nasolacrimal sac area 2-3 times daily
  • Massage should be directed downward toward the nose to help open the membrane at the distal end of the nasolacrimal duct
  • Clean any discharge with warm water and a clean cloth

• When to refer to ophthalmology:

  • Routine referral if symptoms persist beyond 6-9 months of age 1
  • Urgent referral if signs of infection develop (erythema, increased swelling, warmth) 1
  • Immediate referral if dacryocystocele is present due to high risk of complications 1

For Infectious Conjunctivitis (If Suspected)

• If purulent discharge is present, consider bacterial conjunctivitis 2

• Treatment: Erythromycin ophthalmic ointment applied directly to the infected eye(s) up to six times daily, depending on severity 3

  • Apply approximately 1 cm in length of ointment directly to the lower conjunctival sac 3
  • Continue treatment for 5-7 days 2

• For suspected chlamydial conjunctivitis:

  • Consider if mother has history of untreated chlamydial infection 2
  • Requires systemic treatment with oral erythromycin as well as topical therapy 2
  • Parents should also be evaluated and treated to prevent reinfection 4

Special Considerations

• Dacryocystocele: If bluish swelling is present over the nasolacrimal sac area, this represents a dacryocystocele which requires urgent ophthalmology referral due to high risk of infection 1

• Acute dacryocystitis: Presents with erythema, swelling, warmth, and tenderness of the lacrimal sac - requires immediate treatment to prevent complications such as periorbital cellulitis, orbital cellulitis, meningitis, brain abscess, and sepsis 1

• Congenital anomalies: Some infants may have structural abnormalities of the lacrimal system such as punctal and canalicular atresia, which may require surgical intervention if conservative measures fail 5

• Warning signs requiring immediate referral:

  • Photophobia
  • Excessive tearing with enlargement of the cornea
  • Clouding of the cornea
  • These may indicate congenital glaucoma, which is an ophthalmologic emergency 2

Follow-up

• Regular follow-up during well-child visits to monitor resolution 6
• Parents should be advised to return sooner if:
  • Discharge becomes purulent
  • Eyelids become red or swollen
  • Baby develops fever or becomes irritable
  • Symptoms worsen despite conservative management 1

Remember that while watering from the eye can be concerning for parents, nasolacrimal duct obstruction is common in infants and has an excellent prognosis with conservative management in the vast majority of cases 1.