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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Ophthalmology

Blocked Tear Ducts in Children (6116)

Blocked Tear Ducts in Children (6116) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Ophthalmology

6116








Blocked Tear Ducts in Children


Blocked tear ducts are a fairly common problem in children. About 5% of babies have problems
with their tear ducts. Most of these children get better on their own. This handout will help you
understand what a blocked tear duct is, and how it can be treated.


Normal Tear Ducts

Tears are made in the tear gland which is under the upper eyelid near its outer corner. You can
see it in the drawing below. Tears come from this gland all the time, and keep the eye moist. At
the same time, tears are draining away from the eye through 2 holes, one on the upper and one on
the lower eyelid. These holes are called the puncta and are openings to the tear drainage system.
You can see the puncta on this picture. If you look
closely at your own eyelids in a mirror, or those of
your child, you should be able to see these pinpoint-
sized openings on the edge of the eyelids near the
nose. After passing through the puncta, tears flow
through a canal in the upper and lower eyelid called
the canaliculi. These canaliculi then merge and
empty into a larger sac that is called the lacrimal (or
tear) sac. Tears then exit through the bottom of the
tear sac to drain through another duct—the
nasolacrimal (or tear) duct that goes through the
bone into the nose. That is why your nose runs
when you cry. These structures, the canaliculi, tear
sac, and tear duct, are all under the skin and cannot
be seen. The picture helps to show where they are.


Blocked Tear Ducts

Before a baby is born, there is a membrane that blocks the opening between the tear duct and the
nose. Around the time a child is born, the membrane should open up. If this does not happen, it
can result in a blocked tear duct. This may happen in one or both eyes. There can also be other
reasons that the tear duct is blocked. If the tear duct is blocked, tears may still enter the upper



part of the tear drainage system (puncta, canaliculi, tear sac), but they cannot drain all the way
into the nose because of the blockage. Think of this like a sink in which the water is running, but
the drain is plugged. In the case of a sink, the water will overflow. In the case of a blocked tear
duct, the eye waters all the time and the tears drain down the child’s cheek. Mattering (pus-like
drainage or crusting of the eyes) is common in children with blocked tear ducts. The tears that
are trapped in the tear sac can become infected. This causes pus-like drainage from the eyes.
Often the eyelids are mattered and stuck shut in the morning. Parents may be surprised to hear
their child’s tear ducts are blocked, when the child’s eyes are always watery. When you realize
that it is not the gland that makes the tears that is blocked, but the duct that drains the tears away
from the eye, this makes more sense. Even though the blockage of the tear ducts is present at
birth, there often are no signs until a child is several months old. This is because a newborn’s
tear glands do not produce as much liquid as they do when the child is a bit older. The
symptoms of blockage of the tear duct do not appear until your child makes more tears.


Treatment of Blocked Tear Ducts

We have found that about 85% of children with blocked tear ducts get better on their own. At
first, treatment is aimed at keeping the mattering
(infections) from getting out of hand, and helping the
blockage open on its own. In very mild cases, nothing
may need to be done while you are waiting for healing.
If there is a lot of mattering in the eyes, antibiotics in the
form of eye drops or ophthalmic ointment may be used.
This often causes the mattering to resolve very quickly.
Antibiotics will not do anything to open up the tear
ducts. They simply buy your child time while the tear
ducts mature enough to open. Because of this, parents
of babies with blocked tear ducts often tell us that their
baby seems cured while on the eye drops. In this case,
though, the problem will come back when the eye drops
are stopped.

Sometimes massaging the tear duct may help open it.
The drawing below shows how you should do this. You
should place your thumb or forefinger on the skin just
above the tear sac. Then, with a rather firm movement,
you should stroke downward. The idea is to get some of
the pus or fluid that is in the tear sac trapped between
your finger and the membrane that is blocking the tear
duct. With firm downward pressure, the pus or fluid
may be squeezed downward and rupture the membrane.
If that occurs, the symptoms of a blocked tear duct
improve quickly. It may help to think of this as “milking” the tear duct. Parents should do this
for about 5-10 strokes, 3 or 4 times a day for several weeks.





Probing of a Tear Duct

If a blocked tear duct does not improve, the next step is to probe the tear duct. This involves
passing a thin wire probe into the puncta and down the tear duct to open the membrane. If the
tear duct is blocked because of the membrane at the bottom of the tear duct, this is almost always
successful.

A small number of children may need a more involved treatment. Sometimes the tear duct
system has more a complicated type of blockage. There may be strictures in the canaliculi, or
the tear duct system may have not developed properly. Your eye doctor can tell if this is the case
at the time of probing. If a more complex type of blockage is found, simple probing may not
help.


When a Tear Duct Should Be Probed

Most children with blocked tear ducts will get better in the first few months of life. By the time
a child is 6 months old, there is still a good chance he will get better but the odds are less than
they were at birth. Most (but not all) children who are going to improve do so by their first
birthday. There is no “perfect” time to probe a child’s tear ducts. Many pediatric eye doctors
feel comfortable probing a 6-month old child in the office, without the need of anesthesia. By
the time a child is a year old, they are often too big and active to safely treat in this manner. If
your child is going to need to have his tear ducts probed, it may be better to do it at about six
months of age in the doctor’s office. By doing so, your child may be able to avoid having
general anesthesia and the procedure done in the operating room. There is always the chance
that your child’s tear ducts may open on their own, if you wait until your child is about a year
old. However, if you choose to wait, it may require an operating room visit to do the procedure.
You should talk to your child’s doctor about your options and what is best for your child.


What to Expect if your Child Has a Tear Duct Probing

After a tear duct probing, there may be mild bloody drainage from the nose and/or the eye for
several hours. This is normal. You may be given any eye drops or ointment to put in the eye(s)
several times a day for a week or so after the probing. You do not need to limit your child’s
activity.














If Tear Duct Probing is Not Successful

Most of the time, a simple tear duct probing will cure a blocked duct. For those children where
probing is not successful, there are other options. One is to repeat the probing and insert a
silicone tube in the tear duct. Leaving the tube in place for a few months may prevent the tear
duct from scarring closed. This can be helpful when the blockage is in the upper part of the tear
duct system. The probing can also be repeated with a special probe that has a balloon at the end.
The balloon can be blown up in the tear duct to stretch it open. Less commonly, surgery may be
needed to make a new drainage opening for the tear duct system.

If you have questions or problems, please call your doctor.

Your doctor is __________________________________


Phone Numbers

Pediatric Eye Clinic, Monday to Friday, 8:00 am to 4:30 pm (608) 263-6414
After hours, the number is answered by the paging operator. Ask for the eye resident on call.
Leave your name and phone number with the area code. The doctor will call you back.






















Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright 1/2016. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing HF#6116