Examination (watery eye in infant)

Examination:

• examine vision and ocular function
• vision - tested by slow pursuit movements e.g. in response to face or toy
• eye is generally white; some conjunctival hyperaemia is acceptable
• cornea should be clear and normal size with sharp iris detail
• corneal reflexes are central
• red reflexes present
  
  
• any signs supportive of lacrimal duct obstruction
  • such as a thick tear film that often overflows, a swelling at the inner canthus (secondary to a lacrimal sac mucocele)
    
    
• look for mimics of lacrimal duct obstruction
  • lid or lash abnormality
  • chlamydial conjunctivitis - typical is a sticky eye and a plushy hyperaemic appearance of the lower lid conjunctiva - can continue to over 8 months in age - if in doubt take chlamydia swabs
    
    

BMJ (1997), 315, 293-6.