Blocked tear duct surgery

Your child's doctor has recommended surgery to clear and/or prevent blockages in your child's tear ducts.

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
• dacryocystorhinostomy
  

Probing and irrigating

Probing and/or irrigating is the most common surgery for blocked tear ducts.

1. A thin blunt probe is inserted from the punctum into the lacrimal duct to open the blockage.
2. A second probe is inserted into the nose to make contact with the first probe and make sure the duct is open.
3. 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.
4. 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

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. The surgery can be performed through an incision in the skin between the nose and the eye. It can also be performed through the inside of the nose without leaving any scars on the skin.

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.

Eye patch

Your child does not usually need a patch after this surgery. If your child does get an eye patch, 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:

1. 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.
2. Wash your hands.​
3. Soak a clean face cloth in the cool water.
4. Squeeze any extra water out of the cloth, then place the cloth on the swollen eye(s).
5. Leave the cloth on for no more than two minutes at a time.
6. Repeat a few times.
7. 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.

Antibiotic drops

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. If they feel their nose is stuffy, you can use a saline nasal spray (Salinex) to help clear it up.

Tubes

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.

Swimming

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.

Sun exposure

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.

Follow-up appointments

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 an upset tummy
  
• 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:

Name: ________________________________________

Phone number: _________________________________

At SickKids

If your child's doctor is not available, call the hospital at 416-813-7500 and ask to speak to the eye doctor on call.