Nasolacrimal Duct Obstruction:

General information

Normally, tears drain through small openings called lacrimal ducts, which start from the eyeball and reach the nasal pyramid. An obstruction of the lacrimal duct occurs when the opening channel, which normally allows tear drainage, is blocked or is not opening properly.

If the lacrimal duct is obstructed, the lacrimal sac fills with liquid and gets swollen and sore; sometimes it gets infected. It is considered that the obstruction of the lacrimal ducts occurs in 30% of newborns. Anyway, the symptoms appear only in 2% to 4% of newborns. Taking into consideration that symptoms appear only in 2% to 4% of newborns, it is necessary to consult a pediatric ophthalmologist. The “Oculus Prim” pediatric ophthalmologist provides correct diagnosis and efficient treatment.

Causes in newborns

The most common cause of lacrimal duct obstruction in newborns is the incapacity of the covering tissue in the opening channel to open properly during or around birth.

Other less frequent causes of lacrimal duct obstruction in children are:

• Infections;
• Abnormal development of the nasal bone, which puts unusual pressure on the lacrimal duct, closing it;
•  The opening of the lacrimal ducts in the inner corner of the eye (the place where the tears drain in the lacrimal ducts) is closed or underdeveloped.

Diagnostics

Frequently, the symptoms appear within the first week of life, so it is rarely diagnosed at birth. Sometimes, it may occur even later, taking into account that children don’t have tears immediately after birth.

Thus, the most frequent symptoms are:

• Watery eyes with the accumulation of tears in the inner corner of the eye or their leakage on the cheek (without the baby crying);
• Yellow mucous or mucopurulent secretions at the eye level; this discharge is caught in the eyelashes or even in the eyelids, especially upon waking up;
• Swelling of the eye (in the region next to the nasal base and the lower eyelid level); this swelling is caused by the accumulation of tears in the lacrimal sac which enlarges it and contributes to the swelling; frequently, if pressure is applied at this level, the excess secretion is eliminated through lacrimal puncta (points);
• Redness of the eyes, especially if the child is exposed to dust, cigarette smoke, wind or if the child cries (these are the situations when the secretion of the tears normally increases) and because the drainage ducts are obstructed it can lead to the inflammation and redness of the eye.

These symptoms take a long time to evolve, with spontaneous remission periods, as well due to local treatment. In a majority of cases, the condition gets better without any treatment during the first year of life. Still, if taking into consideration the fact that the symptoms described above occur in other disorders of the eyeballs, it is necessary to consult a specialist. The “Oculus Prim” pediatric ophthalmologist provides correct diagnosis and efficient treatment.

Generally, providing a diagnosis is relatively easy, but it has to be established by a pediatric ophthalmologist based on the history described by parents, as well as on the medical evaluation. As highlighted before, all symptoms must be attributed to the correct condition, in order to differentiate the ones related to neo-natal conjunctivitis, which can lead to severe complications.

Additional medical investigations are rarely needed, investigations like fluorescein leakage test or bacteriological examination of secretions when infected.

Treatment

Children born with lacrimal duct obstruction don’t usually need treatment. In more than 90% of cases the condition gets better without any treatment during the first year of life. Treatment measures undertaken at home, like cleaning the eyes and draining the duct, can help prevent infections. Usually, antibiotics are necessary only if there are signs of infection like redness, edema or yellowish secretions.

If the duct is still obscured by the age of 6 months old, a simple procedure like probing the lacrimal duct is conducted. This will open the lacrimal duct in more than 90% of cases.

There isn’t a consensus regarding the age, but the results are excellent when the intervention is performed until the age of 1 year old, as chronic inflammations often occur if there are frequent infections, inflammation which can cause an unsuccessful probing, the obstruction rebuilding after a short period following the procedure. In these cases, there is one solution – to implant a silicon tube at the duct level in order to maintain it permeable for a few months, after which it is removed and the nasolacrimal duct becomes permeable.

This intervention is performed only at the instruction of a pediatric ophthalmologist, in sterile conditions and under anesthesia. The intervention itself is short and there aren’t any inconveniences afterwards. 

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