Dacryostenosis

WHAT YOU SHOULD KNOW:

  • Dacryostenosis occurs when one or both of your child's tear ducts are blocked. Dacryostenosis is also called congenital nasolacrimal duct obstruction (CNLDO). Congenital means that your child was born with this condition. A tear duct is a small passage extending from your child's eye to his nose. Normally, tears drain through a hole in the inner corner of your child's eyes into his tear duct. When your child's tear duct is blocked, tears cannot drain properly. Your child may be more likely to have dacryostenosis if he was born with a disease like Down syndrome. Dacryostenosis is also more common in children who were born with head or face problems.

  • Dacryostenosis often occurs because skin tissue blocks the opening of your child's tear duct into his nose. If your child has complete dacryostenosis, no tears can drain. With partial dacryostenosis, some of your child's tears may still be able to drain. Your child's symptoms may become worse during certain weather conditions such as extreme sun, wind, or cold. His dacryostenosis may also become worse when the skin tissue in his nose is swollen. Your child's tear duct will usually open up on its own without treatment. Having your child's dacryostenosis treated may stop tears from overflowing onto his eyelids and face. Treatment may help prevent your child's eye from swelling and getting a serious infection from germs called bacteria.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

  • Your child may get an infection. Surgery may make a fake tear duct (false passage) that does not actually drain. Your child's eye or nose tissue may be injured. Scars may form in your child's tear ducts. This may make another surgery difficult. If a tube was inserted into your child's tear duct, your child may pull it out by mistake. The tube may move out of place or break, which may scratch his eye.

  • Your child may have bleeding from his eye or nose. If the bleeding does not stop, then it is called a hemorrhage. Your child may need another surgery to correct some or all of these problems. Without treatment, your child's eye may continue to spill tears. Your child may get many eye infections. The area around your child's eye may also become swollen. Talk to your child's caregiver if you are worried or have questions about your child's condition, treatment, or care.

WHILE YOU ARE HERE:

Informed consent

is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.

An IV

is a small tube placed in your child's vein that is used to give him medicine or liquids.

Medicines:

  • Anesthesia:

    • General anesthesia will keep your child asleep and free from pain during surgery. Anesthesia may be given through your child's IV. He may instead breathe it in through a mask or a tube placed down his throat. The tube may cause your child to have a sore throat when he wakes up.

    • Local anesthesia: This medicine will make your child more comfortable during a procedure or surgery. It may be placed in his eye, skin, or mucous membranes. It is used to numb the area and dull your child's pain. Your child may still feel pressure or pushing during the procedure or surgery. Medicine to decrease bleeding may be added to the numbing medicine.

  • Topical medicine: This is medicine you put on your child's eyes. It contains antibiotic medicine to help treat or prevent infection. It may also contain steroid medicine to decrease redness and swelling.

Restraints for medical management:

Your child may need restraints to limit his movement during surgery used with local anesthesia. Physical restraints can be cloth bands, vests, or mittens put on your child's wrists or ankles. The restraints will then be tied to the side of the bed.

Tests:

  • Fluorescein dye disappearance test: This test is also called FDT. A special dye is mixed with local anesthesia and placed in your child's eyes. Local anesthesia is a numbing medicine used to keep your child free from pain. Your child's caregiver will use a special light to check your child's eyes for any remaining dye. In children without dacryostenosis, the dye mixture will drain through his tear ducts. With a blocked tear duct, the dye will not drain and will remain on your child's eye.

  • Imaging tests: Some imaging tests require a special dye to be given to your child before pictures are taken. The dye makes the pictures clearer. Children who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell his caregiver if your child is allergic to shellfish, or has other allergies or medical conditions.

    • Dacryocystography: This test is also called DCG. An x-ray machine takes pictures of your child's tear ducts and the bones around it. His pictures may show problems, such as narrowing of the tear ducts or an abnormal opening.

    • Dacryoscintigraphy: This test is also called radionuclide DCG. A small amount of radioactive dye is placed on your child's eye. Pictures are then taken by a special scanner as the dye passes through your child's tear ducts.

Treatment options:

  • Massage: Your child's caregiver may use massage (gentle rubbing) to break the tissue blocking your child's tear ducts. He may also show you how to massage your baby's tear ducts at home. This may help remove the discharge from your child's tear ducts and prevent infection. You may hear a soft popping sound while massaging your child's eyes. Before and after massage, you may need to clean your child's eyelids and eyelashes with warm water.

  • Warm compresses: A warm compress (often a towel) may be pressed on your child's eye to decrease swelling.

  • Topical medicine: This is medicine you apply to your child's eyes. It contains antibiotic medicine to help treat or prevent infection. It may also contain steroid medicine to decrease redness and swelling.

  • Hydrostatic pressure irrigation: Water pressure is used to open up your child's tear duct. Water is passed through a small tube placed into the hole in the inner corner of his eye.

  • Probing: A small, thin instrument called a probe may be used to open up your child's tear duct. Your child's caregiver may use a nasal endoscope to see your child's tear duct better. An endoscope is a long, thin tube with a camera on the end. A tube or small balloon may be placed into your child's tear duct to open it up. Local or general anesthesia will be used for probing.

  • Surgery: Surgery may also be done to make a new passage for tears to drain into your child's nose. Ask your child's caregiver for more information about surgery for dacryostenosis. General anesthesia will be used for surgery.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Dacryostenosis (Inpatient Care)

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