Tear Duct Obstruction
(Nasolacrimal Duct Obstruction)
This refers to a blockage of the drain that empties tears from the eyes. Usually present at birth, a child with a tear duct obstruction will have excessive tears and at times discharge and crusting on the eye surface.
What Is a Tear Duct Obstruction?
The tears are constantly manufactured by glands within the eyelids. After lubricating the eye, the tears normally drain into 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 via the tear duct (a.k.a. nasolacrimal duct). This is why we tend to have a runny nose when we cry! 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.
Approximately six percent of all infants are born with a nasolacrimal duct obstruction (tear duct blockage) affecting one or both eyes. Fortunately, at least 90% of these obstructions will clear without treatment within the first year of life.
What are the Signs of a Tear Duct Obstruction?
As the tears have nowhere to drain, they will well up on the surface of the eye and often overflow onto the eyelashes, lids and cheek. Normally there are bacteria in the tears which also have nowhere to drain when a blockage is present. These bacteria tend to grow within the tear duct and cause a pus-like discharge from the inner corner of the eye and on the lashes — frequently observed when the child awakens.
Making the Diagnosis
The pediatric ophthalmologist will perform all of the necessary tests to confirm that your child has a tear duct obstruction. Other rarer causes of tearing in children will be ruled-out.
Treatment
As the majority of tear duct obstructions will resolve without any intervention by age twelve months, conservative measures are usually recommended. The typical 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 three times daily as needed after the massage. These eye drops should be used only when a yellow or green pus-like discharge is present throughout the day. The eye drops should be discontinued if only a white mucus-like discharge or no discharge is present.
Probing
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 by the first birthday.
- 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 delicate procedure is safely performed when your child is motionless. This is best achieved with a brief "mask" anesthesia at a hospital outpatient surgical facility.
During the probing, small smooth wire 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.
Although the timing of probing procedures remains controversial, the success rate for tear duct probings appears to be better when performed before age 18 months.
Should the first probing fail, a repeat probing with one of several procedural enhancements (e.g. silicone tube stents) is usually recommended.