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Children’s health: eye, blocked tear duct CHILDREN’S HEALTH: EYE, BLOCKED TEAR DUCT
Tears form in the tear glands that lie above the eyeballs within the bony eye sockets. These tear glands continuously produce fluid that flows across the eyeballs and down the slender tear ducts that connect each eye with the nose (nasolacrimal ducts). The two openings into each tear duct are pinpoint in size and can be seen at the edge of the upper and lower eyelids, near the corner of the eye next to the nose.
In newborns, the openings into the tear ducts are often too small. These openings may be further blocked by the silver nitrate or other drops placed in the eyes at birth to prevent eye infections. Blockage of these openings may cause tears to flow out of the outer corner of the baby's eye, even when the infant is not crying. Occasionally, instead of normal eye fluid, green or yellow pus will collect in the eye. This discharge will further block the tiny tear ducts.
If the nasolacrimal duct becomes blocked at the end inside the nose, tearing and possible infection will occur. Blockage at the nose end of the duct can be present at birth, or it may be caused by congestion from a cold or an allergy. When the nose end of the duct is blocked, the nasolacrimal sac between the eye and the side of the nose may swell with fluid and be visible as a distinct lump the size of a green pea.
Signs and symptoms
In infants, simple tearing of one or both eyes is so common as to be considered normal; it is harmless. However, if there is pus in the eye, redness and rawness at the outer coiners of the eyelids, or swelling of the tear sac (with or without redness), treatment may be needed.
Home care
Simple tearing needs no treatment. The tears can be wiped away and the eyelids cleaned by wiping with a cotton ball dipped in sterile water. Call the doctor if the eye is red, pus is present, or the tear duct is swollen. Redness of the skin at the outer corner of the eye, redness of the eye itself, or the presence of pus may be treated with antibiotic eye drops prescribed by the doctor, often over the telephone. If the tear sac at the side of the nose is swollen, your doctor may teach you how to gently massage the tear sac. (Do not attempt to massage the tear sac without a doctor's instructions.)
Precautions
• With home treatment, the eyes should improve within 24 hours. If there is no improvement, notify your doctor.
• If improvement is prompt, continue treatment until the eye is clear for at least two days.
• Repeated problems of eye tearing are common in infants; save the eye drops for possible future use, but check the expiration date on the label before reusing.
Medical treatment
Your doctor's treatment is the same as home treatment. Your doctor can demonstrate the proper method of massaging the tear sac, if needed. If the condition continues past the age of eight months to one year, your doctor may refer your child to an ophthalmologist (an eye specialist) who may surgically enlarge the nasolacrimal duct under general anesthesia.
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