Nasolacrimal Duct Probing...

How Do Tears Drain From The Eye?
Tears are produced by the lacrimal gland and they drain from each eye through two small openings called the upper and lower punctum, located along the upper and lower eyelids near the nose. They then flow through the canaliculus into the lacrimal sac located under the skin on each side of the nose. From the sac, the tears are pumped by the blinking action of the lids into the tear duct. These ducts go through the side bones of the nose and empty the tears into the back of the nose. In simple terms, tears drain from the eye into the nose, which is why your nose runs when you cry.

What causes overflow tearing and mucus buildup around the eyes?
Overflow tearing in children is usually caused by the presence of a persistent membrane that blocks the lower end of the tear duct near the nose. Normally this membrane stretches or pops open before birth. In some infants and children, however, it remains closed, clogging the tear drainage system. This condition is called naso-lacrimal duct obstruction. The blockage may open spontaneously in a few months as the child grows, but in some cases, it must be opened by a simple procedure.

How will I know if my child has naso-lacrimal duct obstruction?
Signs that your child has a naso-lacrimal duct may include:

• Wet-looking eyes or tears flowing over the eyelid
• Moist or dried mucus material on the eyelashes
• Constant buildup of mucus in the eyes
• Redness of the skin surrounding the eyes.

How is naso-lacrimal duct obstruction treated?
Intially, Dr. D may treat the condition with antibiotic eye drops or ointment. Pressure or massage over the tear sac is sometimes recommended however, in our experience, this approach rarely eliminate the problem. In some cases, the passage of time will allow the tear drainage system to open as the bones in the child's face grow and the diameter of the drain enlarges.

If tearing and mucus buildup persists, it may be necessary for Dr. D to open the tear ducts by gently passing a probe through the drainage system. The child is typically given a small amount of anesthesia to keep them relaxed, and the entire procedure takes about 2 minutes. A thin, blunt metal probe is gently passed through the tear drainage system to open the obstruction. Fluid is then irrigated through the system into the nose to ensure that the pathway is open. Children experience no pain after the probing but some blood-staining of the tears or nasal secretion is common and a discharge from the eye may be present for several days. In about 95% of cases, the initial probing permanently opens the system. A second probing may be necessary and rarely Crawford tubes can be used to keep the tubes open if they do not stay open by themselves after probing. Very rarely, further surgery is needed to bypass the blocked tear duct and create a new opening through the bone into the nose.

In general, the management of a blocked naso-lacrimal duct in a child is a relatively easy problem to manage. Our success rate with this condition has been extremely high and the children do very well with the procedure.