EAR DUCT OBSTRUCTION IN NEWBORNS
It consists of a lack of canalization of the tear duct.
It is a relatively common condition: up to 50 % of babies have this problem.
Fortunately, the development of the tear duct is completed after birth, and only 5 % of patients have this problem after the age of 2 months.
During the first year of life, the chances of the nasolacrimal canal unblocking spontaneously are very high and vary depending on the age of the child: at 3 months of age, there is an 80 % chance; at 6 months, 70 %, and at 9 months, 52 %.
SYMPTOMS
CAUSES
The most usual location of the obstruction is the nasolacrimal canal, a duct through which tears flow before reaching the nose. This duct may have a valve at its end, called Hasner valve, which blocks the outflow of tears.
In general, the causes are congenital and are associated with a lack of development of the nasolacrimal canal.
This condition is not hereditary.
TREATMENT
- Tear duct probing
Since the chances of spontaneous resolution are high during the first year of life, treatment with antibiotic drops is recommended during infections, as well as massage of the lacrimal sac to remove infected tears.
After one year of age, surgical intervention consisting of lacrimal probing is recommended. It is a delicate maneuver performed in the operating room which involves inserting a malleable silver rod through the duct to clear the obstruction.
Permeability is immediately checked by irrigation with colored saline solution and direct visualization with a nasal endoscope.
This procedure has a 90 % success rate when performed at one year of age. There are scientific studies that suggest that the success rate drops afterwards, so it is advisable to perform it in children who have already reached one year of age and whose problem has not resolved. - Tear duct intubation with Silastic
Cases that are not successful with the use of tear duct probing require a different procedure called tear duct intubation with Silastic. It involves inserting a thin and transparent tube that runs through the tear duct.
It remains in place for 6 months, after which it is removed and the condition of the tear duct is checked. This procedure is highly successful. - Dacryocystorhinostomy
More complex situations require a dacryocystorhinostomy, which consists of creating a new communication between the lacrimal sac and the nostrils.
In the case of children, it is advisable to perform it endoscopically through the inside of the nose. This surgery is similar to that performed on adult patients.
Is general anesthesia necessary for probing?
Some specialists recommend immobilizing the child and carrying out the probing in the office. We completely disagree with this approach because modern anesthetic techniques, in health care facilities fully equipped with resources for possible complications, carry a very low risk.
Tear duct probing is an operation that is painful and traumatic without anesthesia. Therefore, we perform it under general anesthesia under the care of a pediatric anesthesiologist, in a health care facility with safety measures in the unlikely case of anesthetic complications.
Does probing have a long recovery time?
No. Usually, the child is fully recovered in the same afternoon of the surgery. There may be blood-colored nasal mucus during the first day. If the child attends day care or kindergarten, they may return the day after surgery.
If probing has failed, is it advisable to wait before another treatment?
It is not necessary to wait for the child to grow. In fact, this leads to progressive dilatation of the lacrimal sac which can make resolution of this condition difficult. Therefore, in this case, placing a Silastic tube is recommended.
