Publication Exclusive: Infant presents with tearing, discharge from both eyes

A 4-month-old previously healthy full-term infant presented to her pediatrician with tearing and discharge from both eyes. The mother noted this had been present since birth and did not note any associated symptoms. On exam, the pediatrician noted normal development and bilateral tearing. The infant was diagnosed with nasolacrimal duct obstruction. Warm compresses and nasolacrimal massage were recommended.The patient was sent home; however, a week later she returned to the emergency department with right eye injection and mild edema around the right eye. She was playful on exam and had appropriate intake/output for her age. The emergency department prescribed polymyxin B-trimethoprim eye drops, and the patient was again discharged. A week later, she returned to the emergency department with bilateral ocular discharge and injection in both eyes. Again, she had no change in activity or appetite. She was prescribed erythromycin ointment. She was referred to our clinic for non-resolution of symptoms. The mother noted near complete improvement of symptoms; however, she noted that the right eye “looked smaller than normal.” The patient had no change in activity, appetite, or urination and stool output and had no fevers. Medical history was noncontributory.