Watery eyes in young children are often caused by a problem with the tear drainage of the eye. Tears normally drain through small openings in the corners of the eyelids and enter the nose through small tubes (nasolacrimal ducts).

Signs and symptoms

When the nasolacrimal duct becomes blocked or obstructed, it may cause:

• tears to run down the cheeks
• a sticky discharge to develop
• swelling and redness of the lower lid.

Most watery eyes will get better before the child’s first birthday without any treatment.

What causes it?

The most common cause is a membrane blocking the nasolacrimal duct. The membrane usually breaks open as your child’s face grows.

Treatment at home

Nasolacrimal duct massage

This may help to clear any blockage. The method for massaging is as follows:

1. Wash your hands and ensure your fingernails are short.
2. With the tip of your forefinger, apply moderate to firm pressure to the side of the nose, where the upper and lower lids join, and slide the finger downward for a short distance (1 – 2 cm) whilst maintaining pressure.
3. Repeat five times, twice a day.

Cleaning the eye

Due to tears pooling in the eye, infections can occur. This can cause a yellow/green discharge and sometimes red and itchy/irritable eyes. This can be avoided or treated by washing the eyelids and face frequently with a clean facecloth. The eye can be bathed and flushed once to twice per day with a salt solution made using the following method:

1. boil water
2. put 1 teaspoon of ordinary table salt in a clean cup
3. add 250ml of boiling water and stir to dissolve salt
4. allow to cool to room temperature.

Thoroughly clean your hands before and after you bathe the eye and surrounding areas with the solution.

Antibiotic eye drops

If the cleaning of the eye is not successful in reducing an infection, a short course of antibiotic drops may be required. These can be obtained from your general practitioner.

Will my child need surgery?

Your child may need surgery if their tear duct remains blocked after several months of medical treatment and if the condition does not improve with time or age. This will be conducted as day surgery under a general anaesthetic and may involve:

• Probing and irrigating – to open and flush out the tear duct.
• Silicone tube insertion – inserting a tube to keep the duct open. This will be left in for a few months to ensure the blockage doesn’t reoccur.
• Dacryocystorhinostomy – to make a new opening in the tear sac and the bone in the nose.

Your doctor will identify the best surgery option for your child.

What happens during the surgery?

Probing and irrigating surgery involves a very thin probe being inserted into the tear duct to clear the blockage. A fluorescent dye is then syringed into the tear duct, to make sure that it is open. If a stent is required, this will be inserted into the tear duct after the dye.

A dacryocystorhinostomy can be performed through the nose, leaving no skin incision or externally which will leave a small skin incision.

When to seek help

Call the hospital if your child has any of the following symptoms after surgery:

• Significant swelling of the eyelids or surrounding area with bluish or red discolouration of the skin.
• Sticky eyes with severe amounts of discharge.
• Extreme or increasing sensitivity to bright light.
• Increase in the size of the eyes, or difference in size between the eyes.
• Clouded or hazy view of the coloured part of the eye.

Developed by the Ophthalmology Department, Queensland Children's Hospital. Resource ID: FS306 Reviewed: April 2023

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.