Watery Eyes (Epiphora) In Children: Causes And Treatment

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Blocked tear ducts and allergies are a common cause of epiphora or watery eyes in children. Tears fill the eyes and drain onto the face when the ducts are blocked. Although it looks like weeping, there won’t be an emotional trigger for these tears. Watery eyes can be self-resolving in many children without any interventions or remedies. While a few may need medications or surgeries to relieve the blockage or allergies.

Awareness of the signs and symptoms of blocked tear ducts and other eye problems in children can help parents know when to seek medical care. However, if you are unsure of the underlying cause or the child has other symptoms, it is advised to visit the pediatrician or a pediatric ophthalmology specialist. Read on to know the causes, symptoms, and management of watery eyes in children.

Possible Causes And Treatments For Watery Eyes In Children

Most causes of watery eyes in children can be treated or managed. Read on to know more about the reasons.

1. Blocked tear ducts

This common condition in infants is also known as congenitalⁱA condition present from birth nasolacrimal ductⁱDuct that transports tears from the ocular surface towards the lacrimal sac and, eventually, the nasal cavity obstruction (NLDO) or dacryostenosis. In children with this condition, the opening of the tear duct is not appropriately formed, which might result in watery eyes.

This can occur in one eye or both eyes, may go away on its own, or be intermittent.

Associated Symptoms

Along with watery eyes, other symptoms of blocked tear ducts might include:

• Tear pool at the corner of the eyes.
• Mucus or yellow discharge due to infection because of the stagnant and moist environment in the tear duct; this could also cause sticky eyes in the morning.
• Redness of eyes due to rubbing (1).

Treatment

• The eye doctor would do a physical examination to find out your child’s condition.

• Based on the examination, they might suggest waiting for it to resolve on its own or clearing the duct opening manually using a probe.

• There is conflicting evidence as to when the optimal time is to do the procedure. It is a technically difficult procedure and as with any procedure does not have a 100% outcome.

• Most of these cases resolve spontaneously within the first 6 to 12 months.

• There is some evidence that a lateral nasal massage can speed up the process. Place your thumb or forefinger on the region where the inside of the eye and nasal bone meet. Stroke downward firmly. This might help the pus or fluid that is trapped in the tear sac, to move downward due to the pressure put by the finger. You may try about five strokes, three to four times a day for several weeks. (2).

Point to consider

Children with persistent CNDLO symptoms may benefit from surgical management, which has a success rate of about 95% (21).

2. Allergies

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Watery eyes could also be a symptom of allergies (allergic conjunctivitisⁱInfection or inflammation of the clear membrane that lines the eyelids and eyeball ). The 2021 CDC National Health Interview Survey data reveals that the prevalence rate of seasonal allergies such as allergic conjunctivitis, allergic rhinitis, and hay fever among children could be approximately 18.9%. The cause of such allergic reactions could be an external factor, such as insect bite or sting, dust, mites, mold spores, pollen, ragweed, grass, foods such as dairy, eggs, soy, nuts, hay fever, and sometimes certain medications.

Associated symptoms

• Runny nose
• Nasal congestion
• Sneezing
• Itchy red and swollen eyes
• Headache
• Itchy nose, mouth, and throat

Treatment

Identifying and avoiding the allergy-causing agent can help in preventing allergic reactions. You may also:

• Keep your home dust-free
• Discourage your children from going out and playing when there is pollen in the air
• Clean and replace the filters in your house regularly
• Use wraparound sunglasses when there is dust in the air
• Avoid second hand smoke

If it is not always possible to avoid an allergen, then take your child to the doctor, and they might prescribe antihistamine eye drops and other medications to relieve the symptoms (3).

3. Dry eye syndrome

Sometimes, watery eyes can be due to dry eye syndrome. It may seem unlikely, but dry eye syndrome can stimulate the tear glands to overproduce tears as a protective response (3).

Associated symptoms

• A sensation that a foreign body is in the eye
• Burning sensation
• Rubbing of eyes and redness (4)

Treatment

Once your child’s doctor confirms the diagnosis of dry eye syndrome, they may prescribe eye drops, gels, and artificial tears.

4. Conjunctivitis (pink eye)

Watering of eyes in children could also be due to an infection called conjunctivitis. Also known as pink eye, this is a common eye infection. Pink eye (conjunctivitis) in kids is likely caused due to allergies, bacterial infections (bacterial conjunctivitis), or viral infections (viral conjunctivitis) (5).

Associated symptoms

The symptoms could vary based on what is causing the eye infection, and may include:

• Watery discharge, if the infection is due to viruses
• Pus-filled eye discharge or conjunctival discharge in the case of bacterial infection
• Sometimes, fever and sore throat may also be experienced
• Eyelid swelling or cornealⁱThe transparent portion of the eye that protects the iris and pupil while allowing light to reach the eye ulcers

Treatment

The treatment options vary according to the causative microorganism; your child’s doctor might prescribe broad-spectrum antibiotics and eye ointments in the case of bacterial infections. There are no specific treatments for certain viral infections in children, and they might get better in a week or two. However, antibiotics and eye ointments could be given to prevent secondary infections (6).

Zibby Owens, a mother of four, shares how she treated her daughter’s pink eye. She says, “The next morning, my daughter woke up and said, perplexed, at the top of the stairs, ‘Mama, my eye feels a little funny.’ Uh-oh. I bounded up the steps only to find her right eye completely encrusted. Pink eye. She was blinking repeatedly and purposefully as if the motion would somehow cause the thick layer of crust to magically disappear… I applied wet compresses to my daughter’s eye and pumped her with Motrin (i).”

5. Common cold

Red eyes, with watery discharge, is a common symptom of a cold. If there is pus in the discharge, then it could indicate a bacterial infection.

Associated symptoms

• Runny nose
• Nasal congestion
• Sneezing
• Coughing
• Sore throat

Treatment

Common cold usually gets better on its own in a week. However, you could try certain home care tips such as using humidifiersⁱA device used to increase the moisture in the air , clearing the nasal congestion with a suction bulb, or using some over-the-counter cold medications (consult your doctor if your child is below three years) (7).

6. Eye injuries

Children are susceptible to eye injuries while playing. The injury would be on the white part of the eye. If they are using contact lenses, they might have watery eyes.

Associated symptoms

• Eye pain
• Feeling the presence of a foreign body in the eye
• Teary eyes

Treatment

If the pain is mild and the scratch is superficial, then it would resolve on its own. Rinsing your eye with clear water, avoiding rubbing or touching the eye can help speed up the recovery. However, if the pain is unbearable and if you have noticed damage to the pupil, then take your child to the doctor (8). Moreover, if your child complains of their vision blurring or light sensitivity, contact your doctor immediately.

7. Blepharitis

This condition causes inflammation of the eyelids. Although this is not a serious condition, it might cause complications, such as permanent alteration of eyelid structure, if left untreated.

Associated symptoms

• Ocular discomfort
• Watery eyes
• Redness of the eyes
• Eye or eyelid redness
• A sensation of a foreign body in the eye
• Crusting of eyelids

Treatment

Primary care involves massaging and rinsing the eyelids to remove the dead skin debris and crusting. Your child’s doctor might also prescribe antibiotics (9).

Quick fact

Other eyelid problems, such as eyelid drooping away from the eye (ectropion), can also cause watery eyes in children and adults (22).

8. Other causes

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Watery eyes could also be due to bright light, irritation due to a foreign body sensation in the eyes, eye strain due to prolonged exposure to smartphones, excessive laughing, and yawning.

Treatment

These are normal conditions and usually do not need medical intervention. Rinsing the eyes with water to remove the foreign object and restricting your child’s screen time might help.

When To See A Doctor?

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Take your child to a doctor if you notice any of the following signs, along with watery eyes.

• Eyes exposed to or come in contact with chemicals
• Inflammation and redness with severe pain
• Suspect a major eye injury
• High amounts of eye discharge
• Child is often rubbing the eyes
• Prolonged watering of eyes
• Change in the color of the eye – especially if only one eye is involved and is red and painful – then see a doctor as soon as possible

Be watchful

See a doctor if your child feels a lump or swelling in or around their eye/eyes along with watery eyes (22).

Home Remedies For Watery Eyes In Children

Watery eyes might be a symptom of an underlying cause, so it is always advised to look for other signs and identify the underlying cause. Your child’s doctor would determine the best course of treatment after examining your child’s eye and the additional symptoms.

In addition to the treatment, you may also consider trying some of these home remedies to provide relief to watery eyes. However, try these home remedies only if there is mild pain but no irritation.

1. Saline water: In the case of conjunctivitis, you could consider cleaning the eyes with clean water or normal saline solution before applying the eye ointment (10). Saltwater has been traditionally used as a treatment option for an eye infection, as it has antimicrobial properties.

2. Teabags: There are no studies to prove if tea bags can help in treating the underlying problem for watery eyes. However, some teas such as Rooibos tea and black tea are said to have anti-inflammatory properties that might help in soothing the eye and providing comfort (11) (12). You can place cold tea bags on your child’s eyes, while they keep their eyes closed for 15 minutes.

3. Massage: If your doctor has recommended waiting until your child’s tear ducts open up on their own, then massage might help. To perform the massage,

• Put one drop of the prescribed eye drops in the eye.
• Place your index finger near the side of the nose under the eye to be massaged.
• Move your finger in short downward strokes while pressing firmly.
• Repeat this thrice daily (13).

4. Hot compress: For bacterial eye infections, the American Academy of Ophthalmology suggests soaking a clean washcloth in warm water and placing it on the eyes until it becomes cold (14).

According to a Cochrane review, a warm compress is also said to ensure eyelid hygiene (15). Hot compresses are also considered as traditional treatments for dry eye (16).

5. Cold compress: According to the American Academy of Ophthalmology, applying cold compress might help in reducing watery eyes due to allergies. Soak a washcloth in cold water and put it on the child’s eyes for a few minutes. You can repeat this several times in a day (14).
   

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Can You Prevent Watery Eyes In Children?

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Prevention is possible based on the underlying cause of watery eyes in children. You may try the following measures to prevent watery eyes due to infection, allergies, common cold, or eye injuries.

• Make sure your child does not share towels and bedsheets with people who have conjunctivitis.

• Identify the allergens and try to keep your children away from them.

• Explain the importance of safety and hygiene during playtime and around pets – never touch the eyes immediately after touching something dirty or a pet.

• Include a balanced diet for your children to strengthen their immunity and make them less prone to the common cold.

• If your children are using contact lenses, then make sure they use them properly to avoid infections or injuries to the eye.
• Reduce screen time to prevent eye strain and watery eyes, particularly if they use devices for extended periods. Encourage them to take breaks every 20 minutes to give their eyes a rest.

Infographic: Does Watery Eyes Mean Bacterial Infection?

Watery eyes are not a specific symptom of bacterial eye infection, and they may not be cured with antibiotics. Blocked tear ducts or viral eye infections can cause watery discharge in children. It resolves as the underlying condition resolves. Go through the infographic to learn to distinguish watery eyes from bacterial eye infections in children.

Illustration: Momjunction Design Team

Illustration: Watery Eyes In Kids Causes Symptoms Treatment & Remedies

Image: Dall·E/MomJunction Design Team

Prior to receiving treatment for watery eyes, children commonly experience discomforting symptoms such as eye redness, itching, and a sensation of burning. Watch our informative video to gain more insights.

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