Ophthalmology

Probing Of Tear Ducts (download this page for printing - PDF File)

Many children are born with small or blocked tear ducts. This can cause tearing from the eye as well as mucus discharge. If the tear duct remains blocked by the age of 10 – 14 months it is unlikely to open on its own and usually requires a tear duct probing procedure. Some times the tear sac will fill up with fluid and pressure directed over the tear sack may empty it causing a gush of tears of thick fluid from the punctum. Antibiotics are not routinely prescribed for a blocked tear duct unless there is an associated infection. Antibiotic drops will be prescribed for eye infections and oral antibiotics will be prescribed for deeper infections in the tear sac.

Probing of Tear Ducts

THE PROCEDURE

This takes about 30 minutes including the general anaesthetic and is 90% effective.

Probing: A small probe is inserted into the punctum and is gently passed through the tear duct into the nose.  In many cases this is all that is needed to open the blockage. If the tear duct is found to be quite narrow or severely blocked, a tube may be inserted to keep or stent this passageway open.

Temporary Silastic Tubes (Crawford Tubes): These are fine soft tubes that try to prevent the blockage from reforming by holding the duct open. These tubes do not actually drain tears. They will be left in from several weeks to six months. This tubing is threaded through the upper and lower punctum and the ends are joined together inside the nose.   You will be able to see a tiny bit of tube at the inside corner of the eye. The rest of the tube is hidden inside the nose.

Tube Removal: Removal of the tube(s) is usually done in the office.   The doctor will cut the tubing (where it is visible at the inner corner of the eye) and pull the tube out as though it were a stitch. This is painless and takes only takes a minute.

PRE-OPERATIVE INSTRUCTIONS

  • The Pre-Op Assessment Clinic of the Alberta Children’s Hospital will phone you and advise you of any pre-operative instructions.
  • You will be asked to call the hospital, after 1:00pm the day before surgery, to find out the exact time of surgery.  You will be instructed to arrive 2 hours before surgery.  You can stay with your child before and after surgery.
  • Your child must have NOTHING to eat or drink, after midnight the night before the surgery.  If they eat, the surgery will be cancelled.
  • YOU MUST FOLLOW THESE DIRECTIONS EXACTLY.   Failure to do so may jeopardize the health of your child or cause cancellation of surgery

POST-OPERATIVE INSTRUCTIONS

The doctor will want to speak with you after the procedure. Please stay close by or ask the nurse for a pager so that you can be reached immediately.

  • You will be given a tube of Ointment or a prescription for drops to use two to three times a day for one week.
  • Your child can resume normal activities and meals when they feel up to it.  There is no restriction on bathing or getting the face wet after surgery.

WHAT IS NORMAL AFTER SURGERY:

  • Your child may be drowsy for the next 24 hours.
  • A minor nosebleed.  If so, use cold compresses, have your child sit upright and lean slightly forward.  This should stop in about 20 minutes.
  • Your child may be aware of “something” inside the nose, this is the tube and your child should be encouraged to leave it alone.

WHAT IS NOT NORMAL AFTER SURGERY:

Breathing problems or prolonged nausea is unusual after tear duct probing. Contact the Children’s hospital if there are significant concerns.

WHAT TO DO IF THE TUBE COMES OUT:

The tube has to come out eventually. Many children will loosen the tube themselves. If the tube is still in place after 6 months it will be removed in the office like a stitch. If the tube comes loose, it will hang out in a loop from the inner corner of the eyelid. This is not dangerous nor an emergency. To remove the tube, cut the loop with scissors and gently pull on one end. The tube should easily slide out and you will end up with two small pieces of tubing and one piece of thread with a knot in it. Do not attempt to retrieve the tube through the inside of the nose. The tube can also simply be taped to the side of the nose to secure it and can be removed the following clinic day at the office. The INTACT loop should  NOT  be tugged on forcefully or pushed back in under any circumstances.

 

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