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What We Treat > InfantsNasal Lacrimal Duct Obstruction (overflow tearing)What is Nasal Lacrimal Duct Obstruction? Tears normally drain through small openings in the corners of the upper and lower eyelids called puncta and enter the nose through the Nasal Lacrimal Duct. Nasal Lacrimal Duct Obstruction prevents tears from draining through this system normally. What causes Nasal Lacrimal Duct Obstruction in children? The most common cause is the failure of a membrane at the end of the Nasal Lacrimal Duct (valve of Hasner) to open normally at or near the time of birth. Other causes of blocked Nasal Lacrimal Ducts in children include:
How common is Nasal Lacrimal Duct Obstruction? Over 5% of infants have symptoms of Nasal Lacrimal Duct Obstruction affecting one or both eyes. Over 90% clear spontaneously during the first year of life. What are the signs/symptoms of Nasal Lacrimal Duct Obstruction? Blockage of the drainage system causes tears to well up on the surface of the eye and overflow onto the eyelashes, eyelids, and down the cheek. This usually occurs within the first days or weeks of life. The eyelids can become red and swollen (sometimes stuck together) with yellowish-green discharge when normal eyelid bacteria are not properly "flushed" down the obstructed system. Severe cases result in a serious infection of the Nasal Lacrimal Duct system (dacryocystitis). Can a Nasal Lacrimal Duct obstruct intermittently? The severity of the signs can vary under different conditions such as upper repiratory illnesses ("colds" or nasal congestion) or outdoor exposure such as wind or cold. How is Nasal Lacrimal Duct Obstruction diagnosed? A history of tearing and discharge at a very early age is strongly suggestive of a blocked Nasal Lacrimal Duct. An ophthalmologist is able to perform certain tests in the office to confirm the diagnosis. It is important that the eyes be examined for uncommon but important other causes of tearing in infants including childhood glaucoma. What is the treatment of a Nasal Lacrimal Duct Obstruction? Fortunately, Nasal Lacrimal Duct Obstruction resolves spontaneously in a high percentage of cases. When obstruction is persistent, one or more of the following treatments may be recommended: Nasal Lacrimal Duct massage, topical antibiotic eye drops, Nasal Lacrimal Duct probing, balloon tear duct dilation, and/or Nasal Lacrimal Duct intubation. How does Nasal Lacrimal Duct massage work? Nasal Lacrimal Duct massage can be performed at home to help the Nasal Lacrimal Duct open. A pediatric ophthalmologist or primary care physician can demonstrate the most effective massage technique. When should topical antibiotics be used? Antibiotic eye drops or ointment may be used to treat discharge or mattering around the eye. The medication does not open the Nasal Lacrimal Duct Obstruction and symptoms often recur when the eye drops are discontinued. When should Nasal Lacrimal Duct probing be performed? If the tear duct remains blocked, a Nasal Lacrimal Duct probing may be performed. How does Nasal Lacrimal Duct probing work? A smooth probe (resembling a thin straight wire) is gently passed through the Nasal Lacrimal Duct and into the nose. Using probes of progressively larger diameters can widen a Nasal Lacrimal Duct system. What type of anesthesia is used for Nasal Lacrimal Duct probing? Some younger children have a Nasal Lacrimal Duct probing done in the office using topical anesthetic drops. Older children usually have a brief general anesthetic in an outpatient surgery setting. Sometimes a tube (stent) is placed in the nasolacrimal system while a child is asleep to prevent recurrence of tearing. How successful is Nasal Lacrimal Duct probing? Nasal Lacrimal Duct probing is generally very successful. Over 90% of children have resolution of symptoms after the procedure. Sometimes additional procedures with enhancements are necessary. In rare cases, a more involved operation may be needed to open the Nasal Lacrimal system (dacryocystorhinostomy, DCR). Source: www.aapos.org |
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