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Monday, April 26, 2010

Clogged Tear Ducts - Proper Preventative Care

Clogged tear ducts, a.k.a. nasolacrimal duct stenosis, is a fairly common problem among newborns. The tear duct's opening is located on the inner portion of the lower eyelid. The duct runs from the eyelid to the inside of the nose where it drains into the nasal cavity. For a small percentage of children, the inferior portion of the duct remains closed after birth and does not allow tears to properly drain from the eye into the nasal cavity. For these children, tears flow over the lower lid and down the cheeks.

Children with nasolacrimal duct stenosis often have small amounts of discharge from the duct coming out of the opening on the lower eyelid. This drainage is not cause for concern and can be wiped away gently with a warm cloth.
However, a blocked nasolacrimal duct does increase an infant's risk of infection of the nasolacrimal sac (dacrocystitis) and of the skin under the eye. Parents should seek medical attention for their infant if there is copious discharge from the duct's opening into the eye, if the eye is crusted shut in the morning, if there is any redness in the white of the child's eye, or if there is any redness or swelling of the skin under the eye or around the duct's opening. These infections have the potential to become very serious and require prompt medical evaluation and treatment with antibiotics.

Most children with congenital nasolacrimal duct stenosis will outgrow the problem. As the child grows, the duct also grows and the inferior opening located within the nasal cavity dilates relieving the stenosis and allowing the duct to function properly. By 2- years-of-age, over 95% of children with nasolacrimal duct stenosis have improved on their own.

For the small percentage of children who continue to have a problem after their two-year-old birthday, they should be referred to a pediatric ophthalmologist. Some pediatricians will refer a child after one-year-of-age. However, most pediatric ophthalmologists will give the parents of younger children a choice between watchful waiting and surgery. For children who have not had any severe infections of the duct, a simple surgical procedure in which the surgeon uses a probe to dilate the nasolacrimal duct is all that is needed to rectify the problem. For children who have had an infection of the duct, they may need both a probing of the duct as well as the placement of a temporary stent inside the duct to keep it open while the duct heals.

While watchful waiting is an appropriate decision for the child without a history of infection, children with a history of infection warrant an early referral to a pediatric ophthalmologist as their chances of resolution without surgery is very low.

Proper care of the nasolacrimal duct can mean the difference between an uncomplicated course of stenosis that is self-resolving and one that is complicated by infection and surgery. While many parents are told to simply massage the duct and sac by rubbing their finger in tiny circles in the inside corner of the eyelid this is actually not the proper technique. The massage is not being done to open the duct, as the closed portion of the duct is located within the nasal cavity, and not up by the eye. The massage instead is done in order to relieve the pressure within the duct and facilitate drainage of any discharge within the sac and duct into the eye. If the discharge material is allowed to remain inside the sac and duct, pressure within this area will increase and cause stretching of the inner lining of the nasolacrimal duct and sac. This stretching would allow normal nasal cavity bacteria to escape the confines of the duct and seep into the surrounding skin causing an infection.

Thus, proper massaging technique is essential to drain the nasolacrimal sac and duct and prevent infection. The correct way to massage the duct is to press your finger into the crevice between the inner eyelid and nose, right below the nasolacrimal duct opening and then move your finger up, milking out any discharge through the opening on the lower lid and out into the eye. This should be done a couple of times a day depending on how much drainage the child is experiencing. With this proper technique, the risk of infection is greatly reduced and the chance of the child requiring a surgical correction is less than five percent.

Nasolacrimal duct stenosis is a fairly common problem among newborns. Learning and using the proper massage technique is essential in order to avoid infection and subsequent surgery. By diligently massaging the discharge out of the sac and duct, parents can reduce the pressure and bacterial build up within the system and buy their children time to outgrow this problem naturally.