dacryostenosis

Matting, tearing and discharge from the eyes of your newborn or young infant may be an uncomplicated eye infection, usually contracted when your baby makes the journey down the birth canal. This is generally a simple matter for your baby's doctor to treat with antibiotic drops or ointment. However, persistent matting and tearing of the eyes that fails to clear up with antibiotics is most often caused by narrow or blocked tear ducts.

Blocked tear ducts, or dacryostenosis, is a very common condition of newborn infants, occurring in about 1 in 20 babies born. Technically speaking, dacryostenosis refers to blockage of the drainage system that carries tears away from the eye as they are formed.

Normally tears flow out of the eye through the tiny pores easily visible in the corners of the eyelids nearest the nose. Tears normally drain through the tear ducts into the nose, which explains why one sniffs at a sad movie. The blockage may be temporary, caused by old mucus and debris in the duct; or it may be more permanent, caused by narrowing of the duct or actual blockage. True physical blockage is caused by the failure of a proper channel to form in a little flap of tissue that lies right at the end of the duct where it empties into the nose.

Dacryostenosis appears shortly after birth. The eye collects yellow or green mucus and tears even though it is frequently wiped clean. When antibiotic drops are used for suspected infection, they are to no avail, and the matting continues. Usually only one eye is affected.

Your doctor will tell you then to lay off the drops and that the best treatment is to massage the tear sac and the duct several times daily. He or she will show you the proper technique. It may take weeks or even months to unblock the duct, but this is almost always successful. You will know you are making good progress when the eye does not seem to be matted every day.

Every once in a while, the condition persists despite massage, and it is necessary for an ophthalmologist (eye surgeon) to probe the duct under anesthesia with a fine wire to pop open the blockage. However, eye specialists usually recommend waiting until the child is close to a year old to do this procedure. By then about 95% of kids are cured naturally, and the anesthetic risk is lower. If probing is necessary, the cure rate is about 90% for the first probing, so repeat probing is seldom needed. A very few children will eventually require the placement of an artificial drainage tube to relieve chronic tear duct obstruction.

Complications of tear duct blockage are rare, but can include such things as irritation of the skin around the eye from all the tear overflow, and more serious infections of the tear sac. The tear sac lies just below the corner of the eye along the track of the tear duct. Infections of the tear sac require systemic antibiotics or even surgery. Sudden swelling and redness in the area of the tear sac should be reported to your baby's doctor right away.

Parents should remember that not all excessive tearing in infants and children is caused by tear duct blockage. Excessive tearing may also be a sign of glaucoma (increased pressure within the eye), inflammation within the eye, or external irritation such a corneal scratch or foreign body hidden under an eyelid. Consultation with your baby's physician or ophthalmologist (a medical eye specialist) is important for any case of excessive tearing which seems persistent or out of the ordinary.

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