Congenital tear duct obstruction and Endoscopic surgery

In approximately half of newborn babies, eye watering can be observed from the first months of birth due to the incomplete opening of the membrane present at the place where the tear duct opens to the nose. As tear production increases in the newborn over the months, watering and burring gradually increase. From time to time, inflammation of the lacrimal sac, which is characterized by swelling and redness in the root of the nose where the lacrimal sac is located, can also be added to the picture. These infants, who are usually followed up primarily by pediatricians, are often evaluated as simple conjunctivitis and are tried to be treated with antibiotic eye drops. However, this is often not effective and the symptoms continue when the drug is discontinued. Since the problem in the table here is the mechanical obstruction of the tear duct, the drops instilled into the eye cannot solve this problem. Congenital tear duct obstruction includes various treatment steps from simple to difficult according to the patient’s admission time. Simpler methods are preferred, as the picture is likely to resolve spontaneously in the first 1 year. Lacrimal sac massage is the main treatment at this stage. How to do the appropriate massage should be explained in detail by the oculoplasty surgeon. It should not be forgotten that there will always be burrs in patients. Burr is not a reason to put antibiotic drops in the eye. When the color of the burr turns yellow green, it means that a bacterial infection has been added to the event. This time eye drops should be used in addition to massage therapy. After the age of one, massage is often insufficient. Probing is recommended for patients between 1-2 years of age, silicone intubation between 2-4 years of age, and then tear duct surgery in adults. In all interventions, tear duct occlusion surgery can be performed through the nose without any incision on the skin.

The 3 most frequently asked questions to Dr. Onur Konuk about congenital tear duct occlusion and Endoscopic surgery:

1. Even though I had massage therapy before, my baby’s watering continues. What should I do?

Treatment of lacrimal duct obstruction with massage is usually effective in the first year. Children who do not respond to treatment at this time either have an anatomical obstruction that will require more serious oculoplastic surgery or massage therapy is not applied appropriately. As a result of the proper application of the massage technique, watering disappears in approximately 90% of these cases. In the remaining cases, probing, which is the next treatment step, is required. Although probing requires a short procedure, it is a serious application that requires experience to be done properly and can cause irreversible damage to all tear ducts if done improperly. For this reason, it is appropriate to be applied by an oculoplastic surgeon.

2. Irrigation continues even though probing has been done 2 times before. What do I need to do?

In the treatment of congenital lacrimal duct obstruction that does not improve with probing, it is necessary to insert a silicone tube into the lacrimal ducts. This surgical procedure is an intranasal procedure performed endoscopically with high resolution cameras. With the development of intranasal imaging methods, the entire tear duct is repaired with a thin tube transmitted through all tear ducts from this surgical intervention performed by oculoplastic surgeons. The tube remains in the eye for about 3 months and is withdrawn without the need for anesthesia in outpatient clinic conditions. All procedures are performed with a seamless operation on the nose, no scars are created on the face.

3. My child’s eyes continue to watery despite previous treatments. How can the problem be solved?

Rarely, the level of duct obstruction is severe and the previously described treatment steps are insufficient. In such cases, the child’s own tear duct is abandoned and an alternative way is opened so that the tears can reach the nose. This procedure can be done with nasal endoscopes, or it can be done with an external skin incision in cases such as trauma and congenital upper lacrimal duct obstruction.