Health Library Should My Baby Have a Probing Procedure to Open a Blocked Tear Duct?From Healthwise

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Although there are surgical options for opening a blocked tear duct, this information deals only with the probing procedure. The probing procedure is commonly used to open a blocked tear duct in a baby 6 to 12 months old. Consider the following when making your decision:

• Most blocked tear ducts open on their own by the time a baby is 1 year old. If your baby is almost 12 months old and the tear duct remains blocked, probing may be recommended. It may also be advised if your baby has developed a bluish, bulging area along the side of the nose (dacryocystocele) or is becoming increasingly irritable because of the blockage.
• If your baby is 6 to 12 months old and has had repeated eye infections, scarring may have occurred that makes the opening unlikely to occur naturally.
• Any medical procedure carries some risks. A rare but major risk of probing is that it may cause scarring of the eye's drainage system, which may lead to further blockage and increase the difficulty of opening the tear duct during a repeat procedure.
• A blocked tear duct does not damage vision. Delaying or not having the procedure will not affect your child's ability to see.
• When or whether to have probing is in part a personal decision. If you are uncomfortable with your baby's appearance or find it difficult to keep his or her eye clean, you may want to consider this procedure.

What should I know about the probing procedure for opening a blocked tear duct?

The probing procedure to open a blocked tear duct is usually not done in a baby younger than 6 months of age.

Probing may be done in a doctor's office using local anesthesia if your baby is younger than 1 month of age. For older babies, it is usually done in a surgical center or hospital using general anesthesia. A doctor may use his or her judgment about the need for anesthesia based on the child's age, weight, and temperament.

It may take several days for babies to heal after probing has been done.

Sometimes a probing procedure has to be repeated. Six weeks after surgery, in the doctor's office, the child's tear duct may be checked with a dye solution. If the duct is still blocked, massage and antibiotics are used for 4 to 6 more weeks. Then, if excessive tearing continues, the probing procedure is done again.

Symptoms may return for a short time after the probing procedure is done if the child gets an upper respiratory infection, such as a sinus infection or a cold.

How effective is the probing procedure for blocked tear ducts?

Most blocked tear ducts go away on their own by a baby's first birthday. If a child's tear duct has not opened by the time he or she is 12 to 13 months old, the probing procedure for blocked tear ducts is usually done. Probing successfully opens the duct in about 90 out of 100 babies who have blocked ducts.¹

One study of children with blocked tear ducts showed that the probing procedure worked for:²

• 89 out of 100 children who were probed at age 2.
• 80 out of 100 children probed at age 3.
• 71 out of 100 children probed at age 4.
• 42 out of 100 children probed at age 5.

In most cases, when a young child's blockage is caused by a simple obstruction, probing works well. A simple obstruction usually occurs when a thin tissue covering the opening at the end of the tear duct does not open normally at or near birth. For more complicated types of obstructions, the probing procedure is successful about half the time.

What are the risks of having a probing procedure to open a blocked tear duct?

Every medical procedure has some risks, such as infection and bleeding. These risks are also present with a probing procedure to open blocked tear ducts.

One of the major but rare risks of a probing procedure is scarring of the drainage system between the eye and the nose (lacrimal duct). The scarring cannot be seen on the baby's face. But scarring may lead to further blockage, making it harder to open the tear duct during a repeat probing.

There are also risks associated with anesthesia.

• Children usually need general anesthesia to keep them perfectly still during the procedure, but general anesthesia has greater risks than local anesthesia.
• Local anesthesia has few or no risks, but the pain control is not as good. Also, babies need to be restrained to keep them very still during the procedure. Local anesthesia is not recommended for babies 1 month of age or older.

What are the risks of delaying or not having a probing procedure to open a blocked tear duct?

The risks of delaying or not having a probing procedure to open a blocked tear duct are minimal in young babies.

• In very rare cases, a baby may develop serious infections of the areas surrounding the eye, including infection of the lining around the eye (pinkeye, or conjunctivitis), the skin around the eye (cellulitis), or the tear duct sac located inside and below the lower lid (dacryocystocele). These infections occur because tears well up behind the blockage and provide a place for bacteria to grow.
• Repeated infections from blocked tear ducts may result in scarring of the tear duct (lacrimal duct). This complication is rare and is usually corrected by probing.

Another risk of delaying probing is that babies 1 month of age and older usually need general anesthesia to ensure that they remain very still during the procedure.

A child's vision is not impaired by a blocked tear duct, so delaying or not having the procedure to open a blocked tear duct will not change your child's ability to see.

If you need more information, see the topic Blocked Tear Ducts.

Your choices are:

• Have a probing procedure to open your baby's blocked tear duct if your baby is 6 months to 1 year old.
• Wait until your baby is 1 year old and then reconsider whether this procedure is needed.

The decision about whether to have a probing procedure to open your baby's blocked tear duct takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing the worksheet, you should have a better idea of how you feel about having a probing procedure to open your baby's blocked tear duct. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have a probing procedure to open your baby's blocked tear duct.

Check the box below that represents your overall impression about your decision.

Return to the topic Blocked Tear Ducts.

Citations

1. Olitsky SE, et al. (2007). Disorders of the lacrimal system. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., chap. 624, p. 2587. Philadelphia: Saunders Elsevier.

2. Mannor GE, et al. (1999). Factors affecting the success of nasolacrimal duct probing for congenital nasolacrimal duct obstruction. American Journal of Ophthalmology, 127(5): 616–617.

Author:	Debby Golonka, MPH	Last Updated: April 11, 2008
Medical Review:	Kathleen Romito, MD - Family Medicine Christopher J. Rudnisky, MD, FRCSC - Ophthalmology
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