About one in every 15 infants is born with a blocked tear duct, or nasolacrimal duct obstruction. Signs may be pus around the eye, tears when the child is not crying and redness around the eyelid. In 90% of cases, a blocked tear duct will clear up on its own by the age of 6 months.
Tear duct blockage that persists beyond the age of 6 months can cause a chronic inflammation and some scarring within the lacrimal sac, the area at the beginning of the duct. Tear duct probing is usually recommended for children older than 6-9 months to permanently open the duct, allow the accumulated pus to drain, and eliminate the risk of tear sac scarring.
Duct probing is an outpatient procedure and is usually quick and easy. It requires no incision or bandaging and involves little to no pain for the child afterward. Probing is among the safest of all pediatric eye procedures; serious complications are rare. The risk of serious post-operative infection, bleeding or anesthetic reaction is one in 1,000 or less.
Before recommending tear duct probing, your pediatric ophthalmologist, Dr. Packwood, Hunt or Norman, will carefully consider whether natural correction is taking place, or whether treatment using massage or antibiotics is helpful.
Your child will arrive an hour or so before the scheduled start time and will return home a few hours later. Generally, tear duct probing will take 10 to 15 minutes in the operating room, but the procedure can take longer depending on the complexity of the case.
Duct probing is performed under general anesthesia (your child is completely asleep and feels no discomfort). The anesthesia is administered by an anesthesiologist who is an expert in pediatric care.
Smooth, thin probes (stiff wires) are inserted through the tear duct to open the blockage. The exit site inside the nose will be widened as well. The doctors will sometimes use a tiny balloon catheter to further open the tear duct by stretching the tissues. In other cases, a temporary silicone tube will be left in the duct to prevent re-closure of the obstructed area. This tube is removed a few months later in the office.
Immediately after the surgery, Dr. Packwood, Hunt or Norman will discuss the results with you.
Your child will be taken from the Operating Room to the Post-Anesthesia Recovery Unit, where he or she will awaken more fully while being monitored by the nursing staff. After 15-30 minutes, you’ll be called from the waiting room to join your child in the Recovery Area. Your child will be encouraged to drink juice or eat a Popsicle while we remove the intravenous line.
Antibiotic drops will have been applied to the eye. You may see a few drops of bloodstained tears draining from the natural tear duct opening in the eyelid or a few drops of blood from the nose, but these drops can simply be wiped away with a washcloth or tissue. You may see orange or yellow dye in the nose; this is a harmless dye used to verify that all pus was cleared from the tear sac.
Most children are discharged within two hours after surgery. The nurses will provide you with antibiotic ointment or drops to help healing and prevent infection. Beginning the day of surgery, for five days, place a drop just inside the lower lid or on the lower lashes.
The child usually has minimal post-operative discomfort. The anesthesia may cause mild nausea, and if vomiting occurs, medication can be prescribed. Your child may also have a mild nosebleed, stuffiness, sneezing or nasal discharge up to a few days after surgery.
Once home, your child can resume all normal activities and return to day care or school as soon as you desire. Infants often play within hours after surgery. Older children may be tired for a day. Bathing, showering and even rubbing eyes (if a tube was not placed) will not interfere with the healing.
It can require a week for the tearing and discharge of your child’s eye to disappear. If the eye doesn’t clear completely within 30 days, further surgery may be necessary. About 5-10% of tear duct probings will need to be repeated because the duct scars closed. If re-closure occurs, tiny silicone tubes may be inserted at the second procedure to keep the duct open.
If a silicone tube was placed, you may see a tiny clear tube at the inner corner of your child’s eye, flat against the upper lid. The tube runs down the tear duct into the nose, and will usually be removed in our office after a few months.
Rarely, the tube may dislodge upward and protrude around the eye. The tube is soft and won’t cause any damage to the eye or tear ducts. Call our office at (817) 529-9949 if this occurs.
One of our pediatric technicians will call you one to two weeks after the surgery. If all is well, you won’t need to return to the office for a post-operative check. If you have any concerns, we’re happy to schedule a follow-up appointment for your child. If you have concerns before we call you, feel free to call us at (817) 529-9949.