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Approximately six percent of all infants are born with a nasolacrimal duct obstruction (blocked tear duct) affecting one or both eyes. Typically, 80% of these obstructions will clear by themselves within the first 8 months of life.
What Is a Tear Duct Obstruction?
Our tears are constantly manufactured by glands within the eyelids. After lubricating the eye, the tears normally drain through two small holes ("puncta") located on the inner corner of the upper and lower eyelids. From there, the tears drain into the back of the nose through the tear drainage system (AKA nasolacrimal duct). This is why, when we go to the movies and cry, we get a runny nose! Infants with a nasolacrimal duct obstruction typically have a blockage at the most distant end of the duct, immediately before it empties into the nose.
What are the Signs of a Tear Duct Obstruction?
If the tears are unable to drain, they will collect on the surface of the eye and overflow onto the eyelashes, lids and down the cheek. Bacteria, which are normally drained with the tears, have nowhere to go when a blockage is present. These bacteria grow within the tear sac and cause a pus-like discharge in the eye and on the eyelashes. Occasionally, the sac itself will swell and become red with an internal infection or dacryocystitis. This is treated with oral antibiotics.
Making the Diagnosis...
The pediatric ophthalmologist will perform a comprehensive eye exam, including dilation and refraction to confirm that your child has only a blocked tear duct. Other, more rare causes of tearing in children, like congenital glaucoma or cataracts, will also be ruled-out .
As the majority of tear duct obstructions will resolve without any intervention by age 8 months, conservative measures are usually recommended. The initial treatment protocol includes:
Tear duct massage (as demonstrated by the doctor) three times each day if any signs of a tear duct obstruction are evident.
Antibiotic eye drops may used after the massage. These eye drops should be used only when a dark yellow or green pus-like discharge is present. The eye drops should not be used if only a light yellow or white mucus-like discharge or only clear tearing is present. The drops are typically used three times per day for five days and then stopped. After three rounds of eye drops, a surgical procedure called probing is recommended.
A probing of the nasolacrimal duct is a surgical procedure performed to relieve the obstruction for any of the following reasons:
If the signs of the tear duct obstruction persist at 8 months of age.
If the pus-like discharge persists despite use of the antibiotic eye drops and massage.
If a more serious infection of the tear duct ("dacryocystitis") or infection of the skin over the tear duct occurs as a result of the obstruction.
This procedure can be safely performed in our office, with a local anesthesia, on children under 1 year of age. For children over 12 months old, this is best achieved with a brief anesthesia at a hospital outpatient surgical facility.
The probing procedure is relatively simple and quick. A very soft, sterling silver probe is passed through the tear duct and into the nose. The surgeon confirms an open tear drainage system at the end of this procedure. There are no incisions or scarring from this operation. There is no significant post-operative discomfort.
The success rate for tear duct probings appears to be about 90% especially when performed before the age of 18 months.
Should the first probing fail, a repeat probing is usually recommended.
The content of this Web site is for informational purposes only. If you suspect that you or your child has an ocular problem, please consult your pediatrician, family practitioner, or ophthalmologist to decide if a referral to a pediatric ophthalmologist is required.