by Scott Silverman, MD
Fellowship trained Pediatric Ophthalmologist

Children with Tear Duct Obstruction usually have matting and crusting of the eye lashes.

Have you noticed constant tearing and matting of your baby's eyes? Your child may have tear duct obstruction. Tear duct obstruction extremely common, occurring in 6 of every 100 newborns. Luckily, with conservative treatment, this condition resolves in the great majority of cases.
Tears normally drain from the corner of the eyes, through small openings in the eyelids into the tear duct and down to the back of the nose. That why your nose runs when you cry. When a blockage of the tear duct is present, the tears run down the cheek instead of into the nose. Constant tearing of the eyes and matting of the eyelids results. In addition, tear duct obstruction promotes bacterial growth and recurrent eye infections.

Treatment:
Tear duct obstruction is primarily treated with massage and antibiotic eye drops. Massage clears the pus from the tear duct and promotes opening of the blockage. It is important to massage properly. Done correctly, this process is better described as pressure treatment than true massage. Firm pressure should be applied to the tear duct sac, which is located in the crevice between the eye and the nose. Don't be afraid to push down firmlyotherwise the treatment will not be effective. If pus is expressed when you press down, then you are doing it right. In addition to massage, your doctor may prescribe antibiotic eye drops. These drops should only be used when mucoid discharge or pus is present.

For children that do not improve by one year of age, tear duct probing surgery is usually necessary. One year of age is the optimum time for surgeryallowing adequate time for spontaneous improvement and maximizing the success rate of the procedure. Tear duct probing is a simple surgery. After the child is asleep with general anesthesia, a fine metal probe is gently passed through the natural pathway of the tear duct to clear any obstruction in the passage. Once the pathway is open, the duct is irrigated with water to insure that the pathway is completely clear. The surgery generally takes less than ten minutes to complete and is done on an outpatient basis. In some children a small nasal bone, called the inferior turbinate, can block the drainage of tears. It is sometimes necessary to move this bone to make a clear passage for tears to flow into the nose.

The success rate of tear duct probing is 85%. The success rate is lower for children more than 15 months of age. In children that do not improve after tear duct probing, it is often necessary to place a silicone tube into the tear duct system. This tube is nearly invisible and is left in place for three to six months while the duct heals. As healing occurs, the tissue tightens around the tube but does not completely close the passage. The tube is removed in the office or surgery center later on, thereby leaving a clear pathway as nature intended.

New horizons:
A new device, called the Lacricath™, may avoid the need for silicone tube placement in some children. The device is similar to the balloon catheter used to open blocked heart vessels during angioplasty. The Lacricath™ is a tear duct probe with an inflatable balloon at the end. During the probing, the balloon is inflated which stretches and effectively opens the tear duct blockage. This device is new but initial experience appears promising.