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When a baby is
developing, before they are born, there is normally a membrane
blocking the opening of the tear duct into the nose. Around the time a
child is born, this membrane opens up. Failure of this membrane to
open is the most common cause, but not the only cause, of a blocked
tear duct. This may happen in one or both eyes. One or both of the
eyes may retain tears and/or mucous, the most common symptoms in
children with blocked tear ducts. Just as stagnant water in a pond
breeds bacteria, the tears that are trapped in the tear sac get
infected. This shows up as pus-like drainage from the eyes. Often the
eyelids are stuck shut in the morning. Even though the blockage of the
tear ducts is present at birth, there commonly are no symptoms until a
child is several months old.
Treatment of Blocked
Tear Ducts
It has been estimated
that about 85% of children with blocked tear ducts get better on their
own. Initially, treatment is aimed at keeping the infection from
getting out of hand, and encouraging the natural process of the
blockage opening up. In very mild cases, nothing may need to be done
while you are waiting for healing. If there is much mattering of the
eye(s), antibiotics in the form of eyedrops or ophthalmic ointment may
be prescribed. This usually has a dramatic effect on quieting down the
mattering. However, antibiotics will not do anything to actually cause
the tear duct to open. Their use merely allows us to bide time while
we are waiting for nature to cure the problem.
In many cases,
massaging the tear duct in a specific way may result in the tear duct
opening. You should place your thumb or forefinger on the skin just
above the tear sac. Then, with a rather firm movement, you should
press inward toward the ear on the opposite side.. The idea is to get
some of the pus or fluid that is in the tear sac trapped between your
finger and the membrane that is blocking the tear duct. With firm
downward pressure, the pus or fluid may be squeezed downward and
rupture the membrane. Generally it is recommended that parents do this
twice, firmly, 3 or 4 times a day for several weeks.
Probing of a Tear Duct
If a blocked tear duct
does not improve, probing of the tear duct is the recommended method
of treatment. This involves passing a thin wire probe into the puncta
and down the tear duct to open the membrane. If the tear duct is
blocked because of the mechanism described above (a membrane at the
bottom of the tear sac) probing is successful in about 95% of cases.
In a small number of children, a more involved procedure may be
necessary. Also, sometimes the tear duct system has a more complicated
type of obstruction. There may be multiple kinks of strictures in the
canaliculi, or on occasion the entire tear duct system may have not
developed properly. Your ophthalmologist can tell if this is the case
at the case at the time of probing. If a more complex type of
obstruction is found, simple probing may not be curative. In this
situation, one of the more involved procedures may be needed.
Many pediatric
ophthalmologists feel comfortable probing a 6-month old child in the
office, without the need of general anesthesia. However, by the time a
child is a year old they are often too big and active to safely treat
in that manner. For the patients of doctors who do offer outpatient
office probing, it may be better to perform the procedure at about 6
months of age. By doing so, one is avoiding a trip to the operating
room and a general anesthesia. However, probing the tear duct at 6
months of age, many children may undergo a probing that could have
been avoided if they had waited another 6 months. Conversely, by
waiting until a child is about a year old, one is maximizing the
likelihood of avoiding the probing altogether. However, at that point
one is committed to needing general anesthesia if probing is required.
Even if the procedure is performed in an operating room, it is usually
an outpatient procedure (no overnight stay).
Immediately after a
tear duct probing, there may be mild bloody drainage from the nose
and/or the eye for several hours; this is normal. You may be given an
eye medication (drops or ointment) to put in the eye(s) several times
a day for a week or so after the probing. There are no limitations on
activity after the procedure is completed.
In the vast majority of
cases, a simple tear duct probing is successful in curing the problem
of a blocked duct. For those children where probing is not successful,
there are several alternative treatment options. One option is to
repeat the probing, and insert a silicone tube in the tear duct.
Leaving the silicone tube in place for a number of months may prevent
the tear duct from scaring closed. This option is particularly helpful
when the blockage is in the upper part of the tear duct system.
Another option is to repeat the probing with a special probe that has
a balloon at the end which can be inflated in the tear duct to stretch
it open. This procedure is similar to the angioplasty procedure
that is done to open blocked arteries in the heart. Finally, and
infrequently, an actual surgical procedure may be needed to make a
completely new drainage opening for the tear duct system.
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