How do we- treat tear duct blockage in babies?

26/07/2022

A congenital tear duct blockage is the most common tear duct condition among children. This article provides a short summary of the symptoms, diagnosis and possible treatments.

The lacrimal gland is responsible for producing tears which clean the eye and hydrate it. After cleaning and lubricating, this tear drains through the nose via the tear duct.

When some babies are born, they have a persistence of a membrane at the end of the tear duct (at the valve of Hasner level), thus causing mechanical obstruction of the duct. This is one of the most frequent causes of congenital nasolacrimal duct obstruction (CLDO). Said obstruction could be on one side or both.

Common symptoms are tears, which usually draw attention because they are visible even when the baby is at rest, and can get worse in cold weather and with the wind. At times, you can see dry scabs, secretions, recurring conjunctivitis... and sometimes eczema appears on the eyelid (the tear itself very often irritates the skin and they rub their eyes). These symptoms appear at birth or in the days/weeks following it.

If you suspect that your baby has a CLDO, you should see a paediatrician and/or ophthalmologist to rule out any causes of tears (that are not so common). To get the right diagnosis, it is important that the doctor does a thorough anamnesis (asking about symptoms, when they started, etc) as it will provide a lot of information about the cause of the tears. An examination is carried out on the child/baby and sometimes a tear clearance, a painless test, is carried out on the patient: a yellow drop is put in the eye and we observe how the eye cleans the colourant.

Treatment

Generally, the CLDO goes away on its own over the child’s first months of life, mainly in the first six months. Despite that, we advise parents that, during the first year, they help the tear duct to open by doing a massage (Crigler massage). It is really simple and painless. To perform the massage, slide your index finger downwards from the tears duct, pressing firmly in an attempt to “break” the membrane (by increasing the hydrostatic pressure). We also advise physiological saline solution eye washes.

On occasion, but not very often, antibiotic eyedrops may be administered.

The majority of patients open their tear duct in the first year, but if the symptoms persist after one year, that's when the paediatrician will refer the child to the oculoplastic ophthalmologist/paediatrician (if they have not already been referred).

Depending on the age of the patient and the evolution of the case, different techniques will be indicated for surgery. It can be unobstructed by probing (using a kind of fine wire) or by probing and intubation (placing tubes that are later removed), or by using a catheter with a balloon, which is inflated and thus dilates and opens the channel.

Laser or external dacryocystorhinostomy (DCR) surgery is rarely required. It is indicated in cases where the lacrimal sac is involved (external DCR) or because one of the abovementioned methods fails (laser DCR).

Dr. Ainhoa Martínez Grau, ophthalmologyst at the Barraquer Ophthalmology Centre