TEAR DUCT (NASOLACRIMAL) OBSTRUCTION IN INFANTS QUESTIONS AND ANSWERS How do Tears drain from the Eye? Tears drain from the eyes through two small openings called the upper and lower punctum which are located along the upper and lower eyelids near the nose. They then flow through the canaliculus into the lacrimal sac located under the skin on the side of the nose. From the sac, the tears are pumped by the blinking action of the lids into the tear duct. These ducts go through the side bones of the nose and empty the tears into the back of the nose. Thats why your nose runs every time you cry. What is a Tear Duct Obstruction? A tear duct obstruction is an occlusion of this tear drainage system. Since there is nowhere for the tears to drain, tears and mucous spill over onto the cheek (overflow tearing). There can also be crusting of the eyelashes after sleep. What Causes a Tear Duct Obstruction? A tear duct obstruction is usually caused by the presence of a persistent membrane that blocks the lower end of the tear duct inside the nose. Normally this membrane stretches or pops open at or before birth. In many infants however, it is still closed at birth clogging the tear drainage system. The blockage may open spontaneously in a few months as the infant grows. Are There Other Causes of Overflow Tearing? Very rarely, overflow tearing can be caused by congenital glaucoma. There are other signs and symptoms associated with this serious condition such as an enlarged eye, a clouded cornea, high pressure in the eye, light sensitivity, and infant irritability. Overflow tearing can also be caused by wind, pollen, smoke, or chemical eye irritation. How are Tear Duct Obstructions Treated? Antibiotic drops may be prescribed for infections which occur with the blocked tear duct. Nasolacrimal duct massage may also be of benefit. I recommend the Creigler method of massage which is as follows: Place your finger on the side of your babys nose, just above the eye. With firm pressure, run your finger down the length of the nose. It is very important that the pressure you apply is to the bony part of the nose, not the eye. I recommend a few strokes, 4-6 times daily. If the tearing persists beyond 12 months of age, then opening the tear duct by surgical probing and irrigation may be necessary. How is Probing of the Tear Ducts Performed? This is generally done in the operating room with your child asleep. A thin, blunt metal wire (probe) is gently passed through the tear drainage system to open any obstruction. Fluid is then irrigated through the system into the nose to ensure that the pathway is open. Infants experience no pain after the probing but some blood- staining of the tears or nasal secretions is common. I prescribe an antibiotic drop to be used 4 times daily for 5 days following the procedure. What is the Success Rate Following Tear Duct Probing? Most obstructed tear ducts (about 90%) clear spontaneously by the age of one year. If it doesn’t, then a probing will be necessary. Most studies report a 90-95% success rate with probing done near the age of Policy NN.19.08A Neonatal Program Policy & Procedure Manual Effective Date: 01-OCT-2007 Page 1 of 2 Refer to online version – Print copy may not be current – Discard after use TEAR DUCT (NASOLACRIMAL) OBSTRUCTION IN INFANTS one year. This means that 90-95% of the time, the tear duct stays open forever after one probing. However, there may still be some tearing after the procedure when your child gets a cold, but then the tearing stops once the cold is over. If the probing is not successful, plastic or silicone tubes can be placed in the drainage canals. What Complications Can Occur with Treatment? As with any surgical procedure, there is the possibility of infection or bleeding. Scarring can re-obstruct the opening, requiring additional surgery. Chronic obstruction can lead to infections of the tear sac at any age. What Happens to my Babys Eyes if I Decide Not to Have the Surgery? Tear duct obstructions generally do not hurt the eye or the vision. If your baby does not have the probing, it is unlikely that the tearing will ever go away. Also, there is an increase risk of infection in people with chronic tear duct obstructions. Policy NN.19.08A Neonatal Program Policy & Procedure Manual Effective Date: 01-OCT-2007 Page 2 of 2 Refer to online version – Print copy may not be current – Discard after use .