If your child has a watering eye, and you may have noticed that they develop episodes of conjunctivitis, when the eye becomes red and sticky.
The important thing to remember is that 90% of children with a blocked tear duct will get better on their own by the age of one year. By leaving a child to improve spontaneously, we can avoid general anaesthetic procedures which, while extremely safe, are traumatic to the child and always carry some degree of risk. An exception would be where the child is in constant discomfort from recurrent episodes of conjunctivitis.
It is usually possible to keep the situation under control by three measures:
1. Discharge around the eyes can be removed by gently bathing along the lashes with sterile gauze moistened with sterile saline solution. Wash your hands before and after the procedure and remember that the skin is quite delicate in this area. Never attempt to clean the eye itself.
2. Gentle pressure on the area between the inner angle of the eye and the side wall of the nose may encourage the tear duct to develop. This should be repeated four times daily. Any mucus which regurgitates from the tear duct should be removed as described above.
3. Conjunctivitis is treated as it arises with antibiotic drops. Long-term use of antibiotic is not recommended as it can cause resistant bacteria to emerge.
If the problem persists at one year then we can discuss probing of the tear duct.
When your child is under anaesthesia, I pass a probe along the length of the tear duct into its opening in the nose and then syringe it through to check that it is open.
You should use bathing, pressure and antibiotic drops as described above for two weeks post operatively.
Probing may need to be repeated if the tear duct closes again. If more than two probings are necessary then I place an indwelling silicone tube into the tear duct for three months. A short general anaesthetic is necessary to remove the tube from the nose.
In certain rare conditions it may be necessary to carry out X-rays under anaesthetic to determine the exact site of the blockage.
Very rarely the tear duct is so poorly developed that an adult type of tear duct operation is necessary through an external incision in the side of the nose.
John Pitts is an oculoplastic surgeon in full-time private practice in London and Barbados following a substantive NHS consultant position. He graduated MB ChB from Glasgow University in 1983 and, in 1987, after working in pathology and neurology, he trained in ophthalmology in Glasgow, Nottingham and London. He has travelled extensively, working in centres of excellence in Los Angeles, New Orleans, Melbourne, Barbados, Brunei and Vancouver. He has undertaken Fellowship training in oculoplastics at Moorfields Eye Hospital.
