The Oculoplastics Centre | Adult and Paediatric Lid, Lacrimal and Orbit Surgery Sydney

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Tearing in Children 

 There are many causes of tearing in children but the most common cause is related to a congenital (something you are born with) obstruction (blockage) of the lower portion of the tear duct (nasolacrimal duct).

The tear duct is designed to be blocked whilst the baby is in the uterus. The tear duct then opens at or shortly after birth, designed to occur when babies start to make more tears at a few days to weeks after birth. Up to 1 in 5 babies are born with blocked tear ducts, fortunately most of these will resolve spontaneously (see below for statistics). Overall 95% of babies with tearing from a blocked tear duct will get better by their first birthday without any treatment.

It is important to realise that it is unusual for your child to start tearing anew, beyond the first few months of life. If this occurs, it is important to have your child examined for any other causes of tearing.

Statistics

  • If your child is still tearing at 3 months of age, he/she has 80% chance that it will clear by 1 year of age.
  • If your child is still tearing at 6 months of age, he/she has 70% chance that it will clear by 1 year of age.
  • If your child is still tearing at 9 months of age, he/she has 50% chance that it will clear by 1 year of age.

 

What are the symptoms?

Parents will note watery eyes within a few weeks of birth. Babies will also have mucus discharge especially in the mornings, this will cause the lashes to stick together and "clump".

This accumulation of mucus is just the normal production of mucus by the surface lining of the eyeball (conjunctiva) that can’t be drained away because of the blocked tear duct. This is not conjunctivitis unless the surface of the eyeball becomes red and inflamed. Antibiotic drops should only be used if there is true conjunctivitis.

Who is suitable for tear duct surgery?

Given that most cases will resolve spontaneously by the age of 1, Dr Wilcsek will usually not operate unless tearing is still present at 18 months of age. However if there is recurrent conjunctivitis and severe mucus production, or swelling of the tear sac (a swelling on the side wall of the nose in the area where the nose pad of spectacles would sit) then surgery is usually performed earlier.

What does the treatment involve?

Medical Management - 4 times daily massage of the tear sac. When your child has conjunctivitis, a course of antibiotic drops or ointment may be required.

Irrigation and Probing - Passing a probe down the duct while your child is under general anaesthetic will clear the blockage of the tear duct in about 80% of cases.

Silicone intubation - If the probe passes down the tear duct but your child continues to tear after the procedure then silicone stents are placed in the system and left in for approximately 3 months. Your child will then also require a very short general anaesthetic when the tubes are removed.

Dacryocystorhinostomy (DCR) - If the tear duct is blocked by bone or the tearing continues after the stent is removed, your child may need an operation called a Dacryocystorhinostomy (DCR). During the surgery an alternate pathway is made for the tears to flow into the nose to by-pass the blocked tear duct.

How will my child look immediately after surgery?

After probing or stenting of the tear duct there is no facial swelling or bruising.

What is the recovery time?

Unless DCR surgery is required then your child will be back to usual within 1-2 days of the procedure, however sometimes tearing can take a few days to weeks to resolve.

What are the risks?

The risk is very low. When probing the tear outflow system a false passage can be formed. An intimate knowledge of the system and a broad experience in the area will significantly reduce the risk of this occurring.

A general anaesthetic also carries risk, this risk reduces to the level of an adult at about the age of 6 months, assuming the anaesthetist is experienced in paediatric anaesthesia.

How long do the results of the surgery last?

Once tearing has resolved, there can be an occasional recurrence associated with an intercurrent head cold however this will resolve as the cold passes.

Is there anyone who shouldn't have this surgery?

If your child is less than 18 months of age and doesn’t have a swollen tear sac or recurrent infections usually Dr Wilcsek will advise avoiding surgery as there is a good chance that your child’s tear duct will unblock spontaneously.