What is Tear Duct Probing and Irrigation?
Tear duct probing and irrigation is a procedure used in the treatment of nasolacrimal duct obstruction.
Tears drain from the eyes through the upper and lower punctum, or small openings in the eyelids that are located in the corner of the eye near the nose. The tears then flow into the lacrimal sac and then through the tear duct which empties into the nose.
A blocked tear duct occurs when a thin membrane covers the end of the tear duct or when a blockage occurs in the tear duct. Nasolacrimal duct obstruction occurs frequently. About a quarter of all infants are born with this condition.
Many times, the blockage will open spontaneously as the infant grows. However, sometimes the blockage does not resolve itself. If it has not resolved by 12 months of age, it is unlikely that it will resolve itself.
Blocked tear ducts can cause recurrent eye infections as well as tearing. Many times, the blockage will open spontaneously as the infant grows. Sometimes, a doctor may prescribe massage of the lacrimal sac to help open the tear duct. About 80% of blocked tear ducts resolve by 9 months of age. Despite time and massage, sometimes the blockage does not resolve itself.
If the blockage has not resolved by 9 months of age, the child should see a pediatric ophthalmologist for evaluation. After a complete eye exam, the doctor will decide if the child needs a tear duct probing and irrigation. A tear duct probing and irrigation is usually performed in the operating room under general anesthesia.
Before Surgery
A few days before the surgery, a nurse from the same day surgery department will contact you. They will confirm the scheduled surgery time and tell you what time your child should arrive at the hospital on the day of surgery. Eating and drinking instructions are age-specific, and the nurse will review this information during the call.
Bring a list of all medicines your child is on as well as the physical exam form completed by their doctor. If a child takes medicines routinely, he or she can usually take the morning dose with a sip of water. Notify the doctor of any morning medications prior to surgery.
On the day of the procedure, have your child wear comfortable clothing. Remove any jewelry and fingernail polish before you leave home.
A doctor or nurse practitioner from the anesthesia department will talk to you about the anesthesia. They will also answer any questions you may have.
During Surgery
The procedure takes place in the operating room. Children over the age of 1 may have one parent come back to the induction room to be with them as they fall asleep. This depends on the child's state of health and is at the discretion of the anesthesia provider.
The child will be asleep for the entire procedure and will not feel any pain or any other sensations. Doctors and nurses will monitor your child throughout the procedure.
The doctor will carefully pass a tiny, blunt, metal wire into the opening of the lacrimal sac and through the tear duct. Sometimes, they inject sterile salt water through the tear duct to make sure it is open. The procedure takes between five to ten minutes per eye.
After Surgery
The doctor will speak to with you after the procedure is done and will provide after-surgery instructions including the use of antibiotic drops or ointments.
Your child will go to the recovery room where a nurse will watch them carefully and make sure they are comfortable. After your child wakes up, the nurse will call you to come and sit with the child.
Children should not experience any pain after the procedure. However, they may be tired and infants may be fussy. Tylenol or Motrin can be used for discomfort if necessary. Children may also experience some nausea and vomiting after surgery. You may see blood tinged tears and nasal secretions.
Diet and Activity
Offer your child clear liquids: sugar water, Gatorade, Kool-Aid, Jell-O, apple juice, clear soft drinks or breast milk. If they do okay with clear liquids, you can advance their diet as tolerated.
There are generally no activity restrictions after a tear duct probing. The patient may be tired and unsteady due to the anesthesia, so adult supervision is recommended for a few hours after the procedure.
