• Is there a risk in waiting to do blocked tear duct surgery?


    Question:

    My 18-month-old boy has a blocked tear duct (when tears can’t drain normally from the eye), which didn't open on its own and the doctor is suggesting probing surgery. His eye doesn't seem inflamed or irritated, but he has an excessively watery eye. I'm trying to avoid general anesthesia due to potential health risks, since the boy is very young, and would like to wait a little longer. I'd like to know if there is a risk of vision related problems if we wait?


    Answer:

    The good news is you are not alone with this problem or your concerns. Tearing in infancy is very common and affects almost 15 percent of normal newborns. Most resolve spontaneously (on their own) by about 4 to 6 months. If the blockage persists past 4 to 6 months, the chances that it will open on its own are less than 20 percent and falling every day the child gets older. Most often, surgery is recommended before a year of age. So, it is perfectly appropriate that your ophthalmologist is suggesting surgery for your little one.

    Probing can be accomplished without general anesthesia by ophthalmologists comfortable doing that but most find it safer under general anesthesia because of airway concerns and for the comfort of the child. Most often, the general anesthesia for probing is less than five minutes and only a mask is used. Very often it does not involve an IV or breathing apparatus. If your ophthalmologist suggests a procedure like balloon catheter dilation or stenting of the tear duct based on your child’s age, those procedures involve an IV and breathing apparatus but do not take more than ten minutes in most cases.

    The main risks of tear duct surgery are recurrence of the blockage (in about 10 percent of cases), infection (which is extremely rare), and blood from the eye or the nose. The bleeding usually subsides in a few hours from surgery and is only a few drops of blood mixing with the tears.

    Your concerns are completely appropriate but it is time to treat this obstruction since the chances of spontaneous resolution are extremely low at this point. The risks of general anesthesia in qualified hands are extremely low as well. Furthermore, studies have shown that persistence of a tear duct blockage can lead to changes in the vision in the obstructed eye and we always recommend these children with one sided tear duct blockages have a comprehensive eye exam at about the age of 4 to exclude any of these conditions.


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