This is one of the most common oculoplastic conditions seen in the clinics. It can present in all age groups from newborn infants to elderly population and management differs in different age groups.
1. CNLDO or Congenital blocked tear ducts
Some children may be born with a block in their tear ducts resulting in watery eyes since birth, a condition that is called congenital dacryostenosis. Sometimes there may be red swelling over the tear sac area along with goopy discharge from the eye.
Lacrimal sac massage or crigglers massage, when done in a correct manner will cure most children with congenital dacryostenosis. Your oculoplastic surgeon will show you the correct technique of sac massage for your child. Antibiotic eye drops may also be prescribed if there is discharge from the eye. If the condition is not corrected by 9 to 12 months, it will probably not respond to further massage and a surgery will be required.
The first step of surgery is called probing. It is very safe, can be done as a day-care procedure (night stay in hospital not required). There is no external wound or stitches, no bandage required, and normal activities can be continued from the next day. The best results are achieved at about 12-15 months age with 90% success rate. As the child grows older, chances of successful outcome decrease to about 60- 70%.
A probing can be repeated 3 months later, putting silicone intubation in to prop open the nasolacrimal duct. For children older than 3-4 years, we recommend using silicone intubation routinely at the time of probing. If this too does not resolve the watering, the next step is a bigger surgery (see DCR) where a new passage for tear drainage is constructed.
2. DACRYOCYSTORHINOSTOMY (DCR)
It is a surgery performed to unblock the tear ducts. Our eyes have a fine pipe which drains the tears from the eye into the nose called nasolacrimal duct (tear duct). If it gets blocked, the tears and sticky discharge come out of the eye. DCR or dacryocystorhinostomy is a surgery by which a new passage is created for the tears to flow freely into the nose.
When a nasolacrimal duct is blocked, the tears and secretions accumulate in the lacrimal sac next to the eye. There is the risk of severe eye infection if the condition is left untreated. There may be swelling, pain, and watering due to infection of the tear sac(dacryocystitis), eyelid (preseptal cellulitis) and orbital tissues (orbital cellulitis) which may in severe cases spread to the brain.
If a cataract surgery is planned, a blocked nasolacrimal duct increases the risk of dangerous infection inside the eye with chances of permanent loss of vision; DCR should be done before the cataract surgery.
DCR can be performed either externally, through a small (about a cm) incision on the side of the nose; or endonasally i.e. through the nose.
The external DCR leaves a faint mark near the eye which fades over time. It has the highest success rates, more than 95 % patients have the problem completely solved after external DCR. An endonasal DCR is a scarless procedure as it is done through the nose and the success rates are comparable (about 90-92%).
Trans-canalicular or Laser DCR is a very rapid procedure, with hardly any pain and swelling. However, it has high failure rates and may need a repeat procedure if it fails.