How do tears work?
Tears clean the eyes and keep the surface of the eyes moist. They are produced all the time by the tear glands (lacrimal glands) and flow down across the surface of the eye. They then drain through a small opening (punctum) near the corner of the eye into the tear sac (lacrimal sac). From there, they flow down a tube called the tear duct (nasolacrimal duct) into the nose and throat.
What is a blocked tear duct?
A tear duct that is blocked stops the flow of tears from the eye down into the nose. It can affect one or both eyes.
Causes of a blocked tear duct
A blocked tear duct usually occurs when the nasolacrimal duct fails to open at its lower end in the nose.
The condition can be congenital (it is present at birth) or acquired (it develops later in life). A congenital blocked tear duct affects about one in 25 babies.
Symptoms of blocked tear ducts
- Your child will have wet eyelashes or extra tears. Since the tears cannot drain out of the tear duct, they spill over the lashes, often onto the cheeks.
- Your child’s eyelids may stick together with mucus, especially in the morning. Mucus is a sticky liquid that is normally dissolved in the tears. When tears do not flow well, however, the mucus stays on the outside of the eye. This mucus is normal. It is not the same as pus (a yellowish or greenish liquid), which is a sign of an infection.
- Your child may often have a red eye. This is caused by infections, which are more common when tears do not drain properly.
Extra tears do not always mean the tear ducts are blocked
Extra tears are not always caused by blocked tear ducts. If your child has extra tears, an eye doctor should check your child’s eye(s).
Treatments for blocked tear ducts
There are different treatments for blocked tear ducts. Your doctor will explain which treatment is best for your child.
Medical treatments include massage and antibiotics for any infections. If these do not work, your doctor will recommend surgery (an operation).
Massaging the eye
Gently rubbing (massaging) the lacrimal sac will often help open the tear duct. You will usually need to do this four to six times a day. Your doctor will explain how to massage the lacrimal sac.
If your child has an infection, the doctor may prescribe antibiotic drops or ointment. Make sure you apply the ointment or eye drops correctly.
Surgery for blocked tear ducts
If medical treatments have not worked after several months, your child may need surgery. Your child might also need surgery if the lacrimal sac is infected and the skin between the eyeball and the side of the nose is red and swollen.
Different types of surgery are available. Your doctor will discuss with you which surgery is best for your child. This will be based on your child's age and how serious the blockage is. Your doctor will also discuss the risks involved with any surgery.
What happens during tear duct surgery?
Before the surgery, your child will have a special "sleep medicine" called a general anaesthetic. This will make sure your child sleeps through the operation and does not feel any pain.
Three types of surgery are available:
- probing and irrigating
- silicone tube insertion
Probing and irrigating
Probing and/or irrigating is the most common surgery for blocked tear ducts.
A thin blunt probe is inserted from the punctum into the lacrimal duct to open the blockage.
A second probe is inserted into the nose to make contact with the first probe and make sure the duct is open.
If the surgeon decides to irrigate (flush) the duct, a blunt needle will be inserted and saline solution (sterile salt water) will be flushed through it.
The needle and probes are removed.
Silicone tube insertion
In this type of surgery, the surgeon puts a thin tube into the lacrimal duct. The tube is left in for a number of weeks to stop the tear duct from blocking again.
Dacryocystorhinostomy (say: DACK-ree-oh-SISS-toe-rye-NOSS-toe-mee) is surgery to make a new opening in the tear sac and through the bone into the nose. This lets the tears drain into the nose.
All three types of operation are done as day surgery. This means that your child does not stay in the hospital overnight afterwards.
What to expect after surgery
Pain or discomfort
Your child may have some pain in and near the operated eye. Ask your doctor if you can give your child any pain relief medicine.
Discharge from the eyes
Your child’s tears and the discharge coming out of the nose may be stained with blood for a day or two. This is normal.
There will also be some blood-stained discharge from the area that was operated on. If this happens, apply slight pressure to the operated area with a clean dressing.
Tell your doctor if the discharge or bleeding continues for more than a couple of days or if the discharge becomes yellow or green.
Your child does not usually need a patch after this surgery. If your child does get an eye patch, however, your child's doctor will tell you when to remove it.
Tubes in the eye
If your child has a tube placed in the tear duct, they will return to the doctor usually a few weeks or months after surgery to have it taken out while they are awake. Your doctor will give you instructions to follow while the tube is in place.
How to care for your child after tear duct surgery
Cool water compresses
Some doctors will suggest putting cool water or ice water compresses on the eyes to ease discomfort and reduce swelling after surgery. Ask your child’s doctor if your child can have cool compresses.
To make a cool compress, follow these steps:
Fill a clean container with cool water. Cool tap water is fine. If you have well water, boil it and cool it in the refrigerator before you use it.
Wash your hands.
Soak a clean face cloth in the cool water.
Squeeze any extra water out of the cloth, then place the cloth on the swollen eye(s).
Leave the cloth on for no more than two minutes at a time.
Repeat a few times.
Wash your hands again.
Ask the doctor how often your child can have a cool compress. Several times a day for the first one or two days after surgery is often fine. Always wash your hands before and after touching your child's eyes.
Your child's doctor may prescribe antibiotic ointment or eye drops for the affected eye and the surgery site. Make sure you get the prescription and carefully follow the instructions for applying the ointment or putting in the eye drops.
Nose blowing and wiping
Your child should not blow their nose for the first two weeks after surgery. It is fine to wipe the nose gently instead.
Tubes placed in the tear duct do not generally cause any problem. If your child has a tube and the loop becomes very visible in the corner of the eye, attach it to your child’s face with a piece of tape and call your child’s doctor to inform them about it.
Gentle play only for the first week
For the first week after surgery, your child should only do light activities such as gentle playing indoors, using computers or watching TV.
During this time, your child must avoid rough activities, sandbox play, contact sports such as soccer or hockey or anything else that would cause your child to bump into another child. Your child should also avoid bending and any activities that could cause them to get out of breath.
If you have any questions about other possible activities, ask your child's doctor.
School and day care
Generally, children should not go to school or day care for the first two days after surgery, sometimes longer. Please check with your child's doctor. Tell your child's caregiver or teacher about the activities your child must avoid.
Generally, swimming is not allowed for one week after the surgery until your child is seen by the doctor. Your child's doctor can tell you when your child can return to swimming.
Baths and showers
Ask your doctor about baths and showers. Some doctors recommend a bath instead of a shower for the first week after surgery.
Your child should avoid going out in the sun right after surgery. Ask your child's doctor when your child is allowed to go back out in the sun.
You will need to bring your child to a follow-up appointment one or two weeks after surgery. Check with your child’s doctor about when the follow-up appointment should happen.
Write the date and time of the first appointment here:
Sometimes, the surgery may need to be repeated. Your child's doctor will tell you if your child needs another operation.
If your child has a tube in the tear duct, you will need to make a follow-up appointment a few weeks or months after surgery to have it removed.
Write the date and time of the appointment here:
When to call the doctor
Please call the surgeon after the operation if:
- your child cannot see properly
- your child's pain gets worse
- your child has a tummy upset
- your child's eye suddenly gets more puffy
- your child's eye is bleeding.
Write down your child's doctor's name and phone number here:
Phone number: _________________________________
- A blocked tear duct stops the flow of tears from the eye down the lacrimal duct into the nose.
- Extra tears are not always caused by blocked tear ducts.
- There are many treatments for blocked tear ducts. Your child will only have surgery if other medical treatments do not work.
- If your child has surgery, follow all after-care instructions properly and attend follow-up appointments.