Child With Increased Tearing in Right Eye

Murtaza Saifee; Kimberly G. Yen, MD


September 06, 2017

Case Presentation

A healthy 5-year-old Hispanic girl was brought to the pediatric ophthalmology clinic with tearing and yellow discharge from her right eye. The patient's mother stated that she first noted this problem when the patient was 7 months old, but recently the tearing and discharge had gotten worse. She also reported that the tears and discharge would come from a small hole in the patient's eyelid.

The patient and parents denied any pain, issues with vision, or misalignment of the eyes. The mother denied any surgical or ophthalmologic treatment of the patient's right eye, as well as any family history of glaucoma.

On physical exam, the patient was comfortably sitting in a chair. Her visual acuity was 20/20 in both eyes. Her intraocular pressure was 19 mm Hg in both eyes, as measured by a tonometer. Her visual fields were full to confrontation. Pupils, ocular motility, anterior segment, and posterior segment exams were normal, with a cup-to-disc ratio of 0.1 in both eyes. A refractive error of +1.00 in both eyes was found on cycloplegic refraction.

External exam showed minimal tearing from the right eye. Superior and inferior lacrimal puncta were present and patent. A small opening was found in the skin immediately inferolateral to the medial canthus (Figure). Scant fluid was noted to drain from the opening, but no blood or discharge was present.

Figure. The patient's right eye on visual inspection.


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