infants & toddlers
 
Blocked Tear Ducts: A discussion of symptoms and treatment
By Darron Bacal, MD

Happy events such as the birth of your child or, sad events, such as an illness of a family member can cause tearing. However, approximately 5% of all infants, tear for a different reason. They have a blocked tear duct. The medical term for this is congenital nasolacrimal duct obstruction. Normally, tears drain from your eyes into your nose, but if a blockage is present, excess tearing occurs.

What are the signs?

Symptoms start within one month of birth. Affected patients have an overflow of tears (epiphora). Crusting and discharge is often present on the lids. The skin is red and raw. One or both eyes can be affected.

Conjunctivitis- the patient may have an infection of the conjunctiva producing discharge, crusting, and redness without the duct being obstructed.

Pediatric glaucoma or uveitis- these are rare but serious conditions. Affected infants can have tearing, redness of the eye(s) and light sensitivity. If either of these conditions is suspected, prompt consultation with a pediatric ophthalmologist is mandatory.

What are the potential complications?

85%-90% of cases will resolve by one year of age with conservative medical management (massage and topical antibiotics). Cases that have not spontaneously resolved by 12 months of age are unlikely to.

Nasolacrimal duct probing can be performed in the office (typically before 6-9 months of age), or in a hospital setting (typically after 9 months of age). Controversy exists as to the best time to intervene. The success rate of a single probing depends on the patient's age. A large study by Katowitz and Welsh published in 1987, showed that a 97% success rate exists with a single probing for patients under 13 months of age. This drops to 76% between 13-18 months, and 54% between 18-24 months.

Some ophthalmologists will probe again. Others will probe and insert a silicone tube, which stays in place for approximately six months. Recently, balloon catheter dilatation of the nasolacrimal duct has been reported. Success rates have varied widely among different studies.

Nasolacrimal duct obstruction is a common problem, which is usually successfully treated with conservative management or simple probing. Correct diagnosis is essential to avoid missing a more serious pediatric eye disorder.

 

Dr. Bacal is a Pediatric Opthalmologist in private practice with offices in Milford, Orange & Branford. He lives with his wife & son in the New Haven area. NOTE: Dr. Bacal has no proprietary interest in any of the devices or procedures mentioned in the above article. This information should not be used as a substitute for the medical care and advice of your personal healthcare provider.

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