Why is the baby always “tearful”

In the outpatient clinic, parents often bring their months-old baby to the clinic: “The baby is not crying, but why is it always teary, as if there are endless tears?” The most common reason for this situation is that the baby has a congenital condition. Nasolacrimal duct obstruction, about 6% of newborns will suffer from this disease, the main clinical manifestation is tearing.

Tears are secreted by the lacrimal glands above the orbit. The lacrimal glands secrete tears all the time, and the secreted tears are discharged into the nasal cavity through the lacrimal canaliculus. The opening of the lacrimal canaliculus is located in the inner canthus of the eye. From here, the tear enters the canaliculus and the common lacrimal duct, and then enters the lacrimal sac from the common lacrimal duct. The lacrimal sac is a temporary storage pool for tears. When the tear fluid is stored to a certain extent, it is discharged into the nasal cavity through the nasolacrimal duct.

Congenital nasolacrimal duct obstruction is caused by congenital developmental abnormalities of the nasolacrimal duct, usually the opening of the Hasner valve of the lower mouth of the nasolacrimal duct. The normal channel of tear discharge is blocked. In addition to being lacrimal all day long, it is also easy to cause lacrimal sac infection, which is manifested by the outflow of purulent fluid. When the lacrimal sac is squeezed, there will be a large amount of purulent lacrimal fluid reflux.

Children with congenital nasolacrimal duct obstruction can be relieved by lacrimal sac massage in the early stage: first find the position of the lacrimal sac (under the inner corner of the eye, near the bridge of the nose), push up and down with your thumb or index finger, and try to make purulent secretion in the lacrimal duct. Exhaust, press 10 to 20 times each time, 2 to 3 times a day. Neonates can get better gradually in 1 to 2 months through this method. If the symptoms are still not improved after conservative treatment for more than half a year, surgical treatment, such as lacrimal duct probing or lacrimal duct probing, can be considered.