If the lacrimal glands are producing enough amount of tear but the draining duct is blocked than the situation is called epiphora, means watery eyes. In the newborn babies the draining lacrimal duct can be blocked. Epiphora can start in these babies at newborn period or 2 – 3 months after birth. In most of the cases the blockage resolves spontaneously. In children usually, the blocked part is the Hasner Valve located in the nose where the lacrimal duct opens. If the duct is not opened spontaneously massage with pressure is needed over the lacrimal sac located between the eye and nose. In this activity the purpose is to open the closed Hasner Valve. The main issue is to press the lacrimal sac and increase the pressure inside the lacrimal duct that will eventually open the valve. The lacrimal duct is usually opened by regular massage until age of 1. If the lacrimal duct is not opened by massage at 1 year of age probing is needed.
In this procedure there is no cut or suture. Probing is done under general anesthesia. The anesthesia is usually sedation without intubation lasts for 5 – 10 minutes. The child is examined by a Pediatric anesthesiologist before the procedure. After his/her approval the child is ready for the procedure.
In Operating Room, the lacrimal duct is cleaned and probed. In 95% of cases it is a successful procedure. In every year which the child gets older the success rate declines. For this particular reason if the duct is not opened at age 1 with massage, probing must not be postponed. Probing can be repeated in unsuccessful cases according to the physicians’ choice. If the blockage is persisting in the same session a silicone tube can be placed inside the lacrimal duct.
First choice is probing in epiphora, but in resistant cases silicone tube placement can be done. If these methods do not work DSR surgery with sutures or Diod Laser DSR surgery without sutures and silicone tube placement will end all problems regarding epiphora and conjunctivitis in these children for sure.