Blocked tear ducts are very common in small babies. This article discusses the cause and treatments for the condition.

Cause
The tears are constantly being manufactured by glands within the eyelids. Their role is to lubricate the eye and then drain into two small holes ("puncta") which are located on the inner corner of the upper and lower eyelids. Tears drain into the back of the nose via the tear duct or nasolacrimal duct which is why we have a runny nose when we cry!

In infants when the nasolacrimal duct is blocked there is usually a blockage at the most distant end of the duct immediately before it empties into the nose. Sometimes the tear duct is very narrow but in any event the tears have nowhere to drain. They well up on the surfaces of the eye overflowing on to the eyelids and cheek and causing the bacteria in the tears to grow within the blocked part of the duct. A yellow or green discharge appears from the inner corner of the eye and on to the lashes.

Treatment
The majority of tear duct obstructions resolve without any intervention by age twelve months.

The treatment protocol is a conservative one and includes:

• Examination of the eye by a Doctor
• Application of breast milk drops into the eye is frequently effective.
• Tear duct massage three times a day (as demonstrated by the Doctor) and only performed on the affected eye
• Antibiotic eye drops three times daily after the massage and should only be used when a yellow or green discharge is present.
• The eye drops discontinued if the discharge is white or is not present

Further Treatment
A probing of the nasolacrimal duct is a surgical procedure performed to relieve the obstruction for any of the following reasons:

• If the tear duct obstruction persists beyond the first birthday
• If the discharge persists despite massage and antibiotic treatment
• If there is a more serious infection as a result of the obstruction

This procedure is a very delicate one and is carried out under anesthetic. The child is usually allowed home the same day. It is a relatively simple and quick procedure. A small smooth wire probe is passed through the tear duct and into the nose. The surgeon confirms an open tear drainage system at the end of this procedure. There are no incisions or scarring from this operation. There is no significant post-operative discomfort.

Although the timing of probing procedures remains controversial, the success rate for tear duct probing's appears to be better when performed before age 18 months.

Frances Byatt-Smith RN RHV BA Psychology

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