Dacryostenosis

What is dacryostenosis?

  • 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 small holes in the inner corner of your child's eyes. The tears then pass through your child's tear ducts into his nose. When your child's tear duct is blocked, tears cannot drain properly. Dacryostenosis most commonly occurs when 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. His 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. The swollen tissue may press on his tear duct and make it narrow. 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 also help prevent your child's eye from swelling and getting an infection from germs called bacteria.

What increases my child's risk for dacryostenosis?

Dacryostenosis is more common in children with certain conditions. These conditions include Down syndrome and craniofacial disorders. Craniofacial disorders are problems with the tissue or bone of your child's head and face. Ask your child's caregiver for more information about these conditions.

What are the signs and symptoms of dacryostenosis?

Your child's signs and symptoms may be present from birth or start later. Your child may have any of the following:

  • Overflow of tears to his eyelid and cheek even when he is not crying.

  • An eye that is watery, red, or itchy.

  • Discharge (thick, clear, or yellowish fluid leaking from his eye).

  • Crusting around his eyelid.

  • Crying more than usual.

  • Rubbing his eye more than usual.

  • Redness and irritation (discomfort) of the skin around his eye.

  • Bluish swelling near the inner corner of his eye.

How is dacryostenosis diagnosed?

Your child's caregiver will ask about your child's symptoms. He will also ask you when they started. Your child may need any of the following 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.

How is dacryostenosis treated?

Ask your caregiver for more information about these treatments:

  • 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 eye. 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 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.

  • 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 an 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.

  • Surgery: Surgery may be done to make a new passage for tears to drain into your child's nose.

When should I call my child's caregiver?

Call your child's caregiver if:

  • Your child has a yellowish fluid leaking from his eye.

  • Your child acts weak or unhappy (irritable).

  • Your child has a fever (high body temperature).

  • Your child has a nose bleed.

  • You have questions or concerns about your child's condition, treatment, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

  • Your child's eye becomes red, swollen, or painful.

  • Your child's eye starts to bleed.

Where can I find more information?

Contact the following for more information:

  • American Academy of Ophthalmology
    655 Beach St.
    San Francisco , CA 94109
    655 Beach St.
    San Francisco , CA 94120-7424
    Phone: 1- 415 - 561-8500
    Web Address: http://www.aao.org/

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. 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.

© 2013 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.

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