Nasolacrimal Duct Obstruction in Children

Blocked tear ducts are a fairly common problem in children. It has been estimated that approximately 5% of babies have tear duct problems. Although the vast majority of them get better on their own, not all do

Normal Anatomy: Tears are normally made in the tear gland, which is under the upper eyelid near its outer (lateral) corner. Tears are continuously secreted by this gland and lubricate the eye to keep it moist. At the same time, tears are draining away from the eye into the nasal cavity through 2 openings, one on the upper and one on the lower eyelid. Tears then pass through the nasolacrimal system which lies under the skin and passes through an opening in the bone into the nose.

Blocked Tear Ducts: When a baby is developing in the womb, 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 but not the only cause of a blocked tear duct.

Think of this like a sink in which the water is running, but the drain is blocked. In the case of a sink, the water will overflow. In the case of a blocked tear duct, the eye is constantly watering and the tears drain down the child’s cheek. Also, mattering (pus-like drainage or crusting of the eyes) is a common symptom in children with blocked tear ducts. As the system is blocked this can cause recurrent infections. Often the eyelids are mattered and stuck shut in the morning.

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 the duct to open spontaneously.

If there is much mattering of the eye(s), antibiotics in the form of eye drops or ointment may be prescribed. 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 the tear ducts to open up on their own accord with time .Many parents report that their baby seems cured while on antibiotic eye drops, however the problem recurs as soon as the medication is stopped. This is because the obstruction to tear drainage still exists.

In some cases, massaging the tear duct in a specific way may help the tear duct to open. To perform massage you should place your index finger on the skin just above the tear sac on the side of the nose. Then, with firm pressure you stroke downward. With downward pressure, the fluid may be squeezed downward and rupture the membrane. If that occurs, the symptoms of a blocked tear duct may improve. Generally it is recommended that parents do this for about 5-10 strokes, 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 opening of the tear duct in the eyelid 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. If a more complex type of obstruction is found, simple probing may not be curative. .In a small number of children, a more involved procedure involving the insertion of tubes may be necessary. Dr McCreery can tell if this is necessary at the time of surgery.

When a Tear Duct Should Be Probed:

As stated above, about 85% of all children with blocked tear ducts get better without surgery, most children improve on their own in the first months of life. By the time a child is 6 months old, there is still a reasonable likelihood he will get better. Most (but not all) children who are destined to improve do so by one year of age. The procedure is performed in an operating theatre under general anaesthesia; it is usually an outpatient procedure.

What you should expect if You’re Child Has a Tear Duct Probing:

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 to put in the eye several times a day for a week or so after the probing. There are no limitations on activity after the procedure.

If Tear Duct Probing is Not Successful:

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 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. Rarely, an alternative procedure may be needed to establish a completely new opening for the tear duct system.

Conclusion: Although blocked tear ducts represent a very common problem, they can almost always be completely corrected.