The blockage of the tear duct is due to the presence of membrane which is just like a peel of an onion at the lower end of the tear duct. Roughly in 50% of the newborns, it opens spontaneously within a week or so. Soon after the birth as a process of nature. But only 2-6% exhibit the clinical symptoms of watering or sticky eyes due to persistence of this membrane in one or both eyes after 2-4 weeks of age with a rare swelling over the nasal side. Which causes concern to them. Numerous treatment options are available which include the use of antibiotics and simple massage over the area of the tear duct on the nasal side with 10 downward stokes at least 4-5 times a day. (The parents can be trained if they like to attend an Eye Clinic in the hospital)
Seriousness of Tear Duct Blockage
In view of the non-serious attitude or lack of understanding, some parents do not like to prolong the misery of the child through conventional messaging over the duct area and persistently using eye drops. Perhaps they have a fear at the back of their minds that prolonged treatment may ultimately deteriorate the visual acuity of the child. Hence they compel the eye specialist to make a hasty decision for surgical intervention.
Our aim is to save the children from unnecessary procedures and make the parents understand the simplicity and ease of the conventional procedure, to carry out with patience. In 90% of the cases the obstruction resolves within six months with a simple massage. And it is only 10% of cases, where the obstruction persists and we need to consider other options like simple probing through the tear duct or later on surgery but never before the age of one year.
During embryonic development, canalization of the tear duct is usually complete at birth. The duct measures 12mm in length and opens into the nose through an ostium in the middle of the nose. If parents care to see themselves, there is a very small whole (called punctum) on the nasal side of the lower and upper lid, from where the tear duct starts downward and open into the middle of the nose. The punctum drains out the tears carrying all the dirt and bacteria to the safe nasal passages.
Probing the Tear Duct Blockage
Now probing is a very simple procedure under a very short anesthesia, basically it is amnesia and not full anesthesia. We make the child to sleep just for a very short period, say 5 minutes and the surgeon negotiates the tear duct with the help of a small thin soft probe with an electric speed lasting few seconds. The probe is just passed through this punctum in the lid and is whisked out from the nasal side, rendering the duct patent. Soon the probe is withdrawn.
Finally, it is a very simple and safe process and not a real surgery as the parents fear. It causes no damage to the eye or soft tissue. There is no bleeding and no bandage is required. The surgeons are very expert and there is nothing to cause any alarm. The child is allowed to go home instantly with the instruction to continue massage for few weeks. If massage is done seriously and persistently with antibiotic drops, hardly we need probing. If this process fails which is unlikely, surgery will be indicated. Which is to create an alternate passage for the drainage of the tear, but this is rarely required.
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