Your newborn has been screaming for the last 45 minutes. (First it was a wet diaper, then the formula was cold, the onesie was scratchy, worldly existence is a confusing and tumultuous experience, you know — the usual stuff.)
But when you look down, you realize their face is 100 percent dry. How is that possible? They should be drowning in a salty sea of their own tears by now!
Get this: Newborn babies don’t cry tears. Well, not at first, anyway. It does happen eventually. But for the first several weeks of your newborn’s life, crying will involve a lot of red-faced wailing and nothing else.
Your little one’s eyes will start making more tears a couple of weeks after birth. Those wet cheeks will typically appear by about 3 months of age or before.
Here’s more about when you can expect real tears to be shed and what you should do if it doesn’t happen by a certain age.
For the first 2 weeks of your baby’s life, their eyes will be pretty dry — including when they’re crying.
First, a little teardrop 101: The lacrimal glands of the eye make tears. The tears then flow over the eye and drain into the tear ducts. (It’s a popular misconception that ducts make tears.)
Although babies do make some tears from birth, they don’t make enough to be seen as tears when crying.
In addition to being tear-free, you may notice that your baby’s eyes are:
- sometimes briefly crossed or divergent
- red or bloodshot (broken blood vessels during birth can cause a subconjunctival hemorrhage)
- indistinct in color
They may also temporarily have swollen eyelids.
Around 2 weeks old, your baby’s lacrimal glands will begin increasing their production of tears, though you still may not notice much change.
Sometime between 1 and 3 months of age is typically when babies actually start shedding more of the salty stuff when they cry, creating visible tears. (Yes, it will be heartbreaking at first. Yes, you’ll get used to it.)
It’s uncommon for your newborn to cry tears before their lacrimal glands have fully developed.
But if your newborn is at least 2 weeks old and crying tears, they’ve probably just reached the “crying with real tears” phase of life.
Other causes of newborn eye watering include the following:
Blocked tear duct
If your baby’s eyes are actively tearing up at times when they aren’t crying, their tears could be from a blocked tear duct.
As tear ducts finish forming, there can be (usually harmless!) issues with the membrane responsible for moving tears from the eye into the nose. When tear ducts are blocked, the tears back up and overflow into the eye, making them look constantly teary.
This isn’t usually a cause for concern, and most cases of blocked tear ducts resolve on their own by baby’s first birthday.
Occasionally, a tear duct gets clogged enough that the corner of your baby’s eye will become infected. This is called dacryocystitis.
It can be serious in an infant and does need to be treated. So if your baby’s eye also has swelling, redness, or pus, you should call your doctor.
Viruses and bacteria
Your newborn could also have a viral illness, like a cold, or even pink eye (conjunctivitis).
This is especially likely if the tears are accompanied by redness or discharge (and especially if you have any other little germ factories — ahem, small children — at home).
Pink eye is uncommon in newborns but can be serious. See your pediatrician right away if your newborn has a red eye with discharge.
This is most likely a blocked tear duct or pink eye. (A cold or viral illness would produce tears in both eyes.)
As far as telling the difference between the two, a blocked tear duct will cause tears but usually no other symptoms, while pink eye comes with all the requisite gooey grossness and redness.
If your baby is a few months old and still isn’t producing any real tears when crying, most often it’s just a delay that’s within the range of normal. But there may be medical reasons for the delay, so see your pediatrician.
If your little one has previously turned on the waterworks but then starts crying without tears again, it could be dehydration. This will typically come with other symptoms, like vomiting, diarrhea, or poor feeding.
Make sure your baby’s getting enough fluids (either from breast milk or formula) every day. Early signs of infant dehydration include:
- a decrease in wet diapers
- less tears when crying
Serious eye conditions
You may have read that a lack of tears can be a sign of more serious eye conditions, like cataracts, lazy eye, glaucoma, or retinoblastoma.
In reality, there’s no evidence that dry eye is a sign of these conditions. (In fact, glaucoma can cause excessive watering.)
All of these conditions have other symptoms that would be picked up by your pediatrician at well baby visits.
Familial dysautonomia — a rare genetic disorder — can cause a lack of tears, though it’s not specifically an eye condition. Other symptoms include:
- lack of muscle tone
- trouble regulating body temperature
- frequent infections in the lungs
- feeding difficulty
If your newborn is very young, like under 1 month old, crying without tears is totally normal. But you should contact your doctor for next steps if your baby:
- doesn’t develop tears by 2 or 3 months of age;
- only has tears in one eye and visible signs of infection like redness, pus or discharge, or swelling;
- has any unusual eye characteristics, like discolored pupils or cloudy lenses.
Expect a lot of dry-eyed crying in the first few weeks of your newborn’s life.
As time goes by, their eyes should become moister and eventually begin producing tears during all those 2 a.m. crying jags. (If you’re crying, too, that’s totally fine. No judgment here.)
Reach out to your child’s pediatrician if your baby has excessively watery eyes that you think may be caused by infection or an eye condition, or if they still aren’t producing tears after 3 months old.