What are blocked tear ducts?
Children can be born with a blocked nasolacrimal system which is the system which takes tears that are produced in the eye and drains them in to the nose.
What are the symptoms?
Children normally have a watery eye from birth, it can be one or both eyes. As well as constantly watering the eyes are often sticky with a yellowish green discharge. This requires cleaning every morning and on occasions during the day.
If severe, the tears that fall over the bottom eyelid can cause redness and irritation of the skin of the cheek but in most cases children are not particularly bothered by a watery eye or discharge.
What should be done?
It is important to assess whether or not a watery eye or a sticky eye has led to visual problems in your baby or child. Although this is unlikely it is sensible to have a full orthoptic examination and ophthalmological examination of your child’s eyes to establish whether visual development is following the normal course.
What will happen at the Ophthalmological appointment?
During the consultation you will be asked a full history, which includes details of length of pregnancy and type of delivery. Your child will have a full examination looking for abnormalities of the eyelids, drainage holes for the tears and eyelashes. He/she will also be examined by other ophthalmological abnormalities such as cataract and visual inattention. A full orthoptic assessment will be performed by a senior Orthoptist and this will identify any abnormalities in the vision of your child.
What can be done about blocked nasolacrimal duct?
95% of children who present with a blocked nasolacrimal duct will spontaneously resolve in that they will get better without any treatment within the first twelve months of life. It is very important to differentiate a blocked nose lacrimal duct from congenital glaucoma which can also present with watery eye in infancy. However in the latter condition the eyes are not sticky, they are often big and the child is often very light sensitive. The cornea can also appear cloudy.
For those 5% of children who do not spontaneously get better in the first year of life, half of them will get better in the second year of life. Of the half of them that have not recovered a further half will recovery spontaneously in the third year of life.
In practice therefore, providing the blocked nasolacrimal duct is not causing the child any problems, it is more sensible to wait for natural resolution rather than intervening. The process of resolution can be hastened by regular massage of the nasolacrimal duct. This will be explained to you when you come for your appointment. If the nasolacrimal duct has not spontaneously cleared, the nasolacrimal system can be probed with a fine metal wire which will allow unblocking of the nasolacrimal duct. This will allow the normal passage of tears from the lacrimal gland across the front of the eye and down the nasolacrimal system. As there is now no longer a stagnant tears, there is a resolution of all the stickiness that has been part of this condition previously. If your child has this procedure done, he or she will be supplied with some antibiotics drops or cream to use on a regular basis following the procedure.
Occasionally probing does not work and the nasolacrimal system remains blocked. In these conditions a further operation might be required to place tubes through the system. These will then need to be removed under a subsequent general anaesthetic meaning your child will need two general anaesthetics to place the tubes and then remove them. Your child will only need one general anaesthetic for a probing and consequently this is the operation of choice in the first instance. Finally, if probing and intubation fails, a more formal procedure to redirect tears into the nose can be performed, this is a dacriocystorhinostomy and this is similar to the operation that is performed in adults who have an age related blockage of the nasolacrimal system.
