Lacrymal duct

In children tearing is most often due to a congenital malformation of the lacrimal ducts. This is more common in premature babies.

Obstruction of the lacrimal ducts results in chronic and permanent lacrimation, from birth.

It is unilateral or bilateral.

The tears are clear but episodes of infectious conjunctivitis can complicate this picture and cause purulent secretions.

Additional tests
In the office, a slit lamp examination is carried out to look for the causes of tearing.

No x-rays or CT scans are performed on children.

Treatment
From birth to the fourth month 98% of children heal spontaneously or with daily massage of the lacrimal sac without treatment.
 

Between the fourth and the twelfth month, a simple catheterization can be proposed in the event of frequent superinfections.
 

From the age of 1 year a sounding associated with intubation with a silicone probe is indicated. There is no incision, everything is done by natural means. The procedure is performed on an outpatient basis under general anesthesia. The probe is left in place for 6 to 8 weeks and then removed in the office without anesthesia and without pain.

From the age of 6, in the event of failure of previous treatments, surgery to bypass the lacrimal ducts is proposed, in the operating room under general anesthesia. A probe is then put in place for 3 months and removed in the office without anesthesia and without pain.

In adults tearing is most often due to blepharitis. The tearing is then bilateral and fluctuating: it predominates in the wind and in the cold.

When the lacrimation is related to an obstruction of the tear ducts, the lacrimation is unilateral or bilateral. The eyes are constantly running. The tears are clear or purulent depending on the location of the obstruction.

Additional tests
A complete ophthalmological examination is carried out in order to eliminate an irritant cause: blepharitis, malposition of the eyelids, trichiasic eyelash or foreign body.
Dr. Bela will probe and flush the lacrimal ducts with saline to determine the degree of stenosis. This is done in the office, without anesthesia and without pain
A CT scan will be ordered to identify the location and degree of obstruction.

Treatment
Treatment varies depending on the degree of obstruction:

partial stenosis: intubation of the lacrimal passages by a silicone probe under general anesthesia, on an outpatient basis.

complete stenosis: tear duct diversion surgery: DCR or Dacryocystorhinostomy
This is a surgical procedure that creates a new flow path for the tear ducts. The flow will still be in the nose but by another route. A probe is placed at the end of the intervention in this new path. Here is some information about this surgery:

Duration: 1h with one night of hospitalization

General anaesthesia

Procedure:

Anesthesia consultation before surgery
Fasting on the day of the operation
Exit the next day without dressing
Postoperative follow-up:

A probe is placed, visible in the inner corner of the eye but without pain
Do not blow your nose, do not rub your eye and do not pull on the probe
Lacrimation persists until the catheter is removed
Frequency of appointments:

D1: Appointment with Dr. Bela to remove the bandage
D7: removal of sutures
M3: removal of the probe in consultation and without pain