What is a tear duct obstruction?

There is a drainage system to clear moisture from the eye. The final drain pathway is a tube, called the tear duct, that drains into the nose where the tears flow down onto the back part of the tongue and are eventually swallowed. The most common reason for overflow of tears and discharged in infants is a tear duct obstruction.

What are the symptoms of a tear duct obstruction?

The presenting signs of a tear duct obstruction are tearing and mattering without conjunctivitis or red eye. The over abundance and spontaneous overflow of tears is a common problem in infant’s occurring in up to 25%. The signs of excessive tearing and discharge may be present within the first few weeks of life. In other cases, overflow tearing may not be obvious for 3-4 months.

What happens to tear duct obstructions in infant?

The most common cause of excessive tearing in an infant is a tear duct obstruction. A great many infants, more than 90%, will show spontaneous resolution of the tear duct obstruction by 6-9 months of age. Thereafter, the likelihood of clearing without surgical intervention is very low. Therefore, there is very little benefit in delaying the surgical treatment past 9 months of age.

How is a tear duct obstruction surgically treated?

A probing and irrigation procedure is recommended as the initial surgery to treat chronic tear duct obstruction that persists after 9 months of age. To be performed accurately and safely, this brief, outpatient procedure requires the use of general anesthesia. The success rate – the elimination of tearing and mucus in the eye – following the probing and irrigation procedure for tear duct obstruction is about 80% when performed before 14 months of age. For those children who failed a probing and irrigation or are treated at after 15 months of age, there are alternative treatments available including balloon dacryoplasty and the temporary insertion of a tube or stent.

Is all tearing a tear duct obstruction?

Not all tearing in infants is a tear duct obstruction. There are other serious causes of tearing. Infantile glaucoma and corneal problems (such as a scratch or foreign body) may also cause tearing. The symptoms of these problems include tearing, excessive light sensitivity, squinting or blinking, pain, and, in the case of infantile glaucoma, haziness or clouding of the cornea and increased corneal size.

Should I be worried about a tear duct obstruction?

Congenital tear duct obstruction is a very common problem in pediatric ophthalmology. Diagnosis of tear duct obstruction can be made by history and by complete ophthalmologic evaluation to separate this common problem from potentially more serious disorders. Tearing and discharge problems that persist after 9 months require pediatric ophthalmologic surgical intervention. Probing and irrigation is an extremely safe and effective method of treatment.

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Eye muscle surgery is performed in an attempt to correct an abnormal eye alignment (strabismus). Even though eye muscle surgery typically requires a general anesthetic, most people are able to return home within hours after the surgery is completed.
During the surgery, the eye is never removed. The eyelids are held open with a speculum and the eye is gently rotated to bring the muscles into the surgeon’s view. Small incisions are made on the superficial tissues of the eye, the conjunctiva. It is through these openings that the muscles are isolated, sutured, detached, and then repositioned and reattached back onto the eye. It may be necessary to perform surgery on one or both eyes. The eye muscles are reattached to the globe with sutures that absorb within 6-7 weeks. The conjunctiva is also sutured closed and the stitches will be absorbed within the first 2 weeks. Topical eye drops or ointment should be applied several times a day for a week. Discomfort may be moderate initially but should quickly improve within a few days. Recovery time is rapid. People are usually able to resume most of their normal activities within a week. Strabismus surgery is usually a safe and effective treatment for eye misalignment problems.

The two common types of eye muscle adjustment surgery are called RESECTION and RECESSION.

RESECTION is used to strengthen an eye muscle. A small piece of the muscle is removed from the end of the muscle. The muscle is then brought forward and reattached to the eyeball.

RECESSION is a weakening procedure. Eye muscles are made weaker by detaching and reattaching the muscle further back on the eyeball.

Both types of procedures change the “pulley” balance between the opposing muscle on the opposite side of the eyeball. It is this muscle re-balancing that causes the realignment or straightening of the eyes.

Additional Information

What is a Chalazion?

A chalazion refers to the bump or mass in the eyelid caused by the inflammatory swelling surrounding an oil-producing gland in the eyelid called the meibomian gland. The swelling is ususally away from the edge of the eyelid. These are not serious and many will respond well to home treatment. We are not sure why most chalazia (plural of chalazion) occur. However, those individuals with chronic blepharitis are predisposed to the development of chalazia.

What is a Stye?

A stye, or hordeolum, is a very small, but often painful, inflammatory swelling caused by an infection at the edge of the eyelid involving the eyelash follicles and the surrounding tissue.

What causes a Chalazion?

The tiny tube, or orifice, draining the meibomian gland becomes obstructed preventing the natural outlet for the secretion of the oil. The gland’s oil continues to accumulate causing the gland to enlarge. If the obstruction persists, the tissue may rupture into the lid causing inflammation, more lid swelling, and sometimes discomfort. In an attempt to limit the spread of the inflammation, a membraneous wall or capsule will surround the inflamed gland. Sometimes the swelling may point anteriorly toward the skin or posteriorly into the subconjuntival space. Either may allow for spontaneous drainage. However, if absorbtion or drainage does not occur, the inflamation will eventually resolve but leaves a painless, hard lump visible in the lid. Antibiotics are not often indicated as the cause of a chalzion is not an infection.

What causes a Stye?

Although a stye may develop without any apparent predisposing factor, eyelid margin inflammation associated with blepharitis, accumulation of excessive discharge caused by conjunctivitis, or poor eyelid hygiene associated with frequent eye rubbing are common causes of a stye.

How is a Chalazion treated?

As soon as one suspects that a chalazion may be starting, warm compresses or warmed water balloon should be applied. Heat the compress or balloon till warm but not hot. Re-heat as necessary to maintain warmth. The purpose of the moist warmth is to liquefy the thickened oil in the gland in hopes of encouraging drainage and absorption. Apply directly to the involved area. It is best done in short 2 to 5 minutes applications used as often as possible the first few days and then 4 times a day to complete a full week./p>

How is a Stye treated?

As soon as one suspects that a stye may be starting, warm compresses or warmed water balloon should be applied. Heat the compress or balloon till warm but not hot. Re-heat as necessary to maintain warmth. Apply directly to the involved area. It is best done in short 2 to 5 minutes applications used as often as possible the first few days and then 4 times a day till resolved. Topical ophthalmic antibiotics may be helpful. Treat the discomfort using your desired over-the-counter analgesic. Most styes resolve in about a week.

What is a chalazion does not go away?

If the chalazion does not resolve after the first month, it is unlikely to improve further. It is at this time that surgical drainage is recommended. This is a short procedure done in the operating room under anesthesia.

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Sensory means how the eyes perceive the vision and how the brain utilizes this visually acquired information. Motor refers to how each of the eye’s 6 extraocular muscles controls the eye movements and how they are coordinated with the other eye.

The sensory motor evaluation is a special ophthalmologic procedure that may be performed in addition to the complete eye examination. Pediatric ophthalmologists perform this procedure often because we are specialists in strabismus. Strabismus refers to those states of the eyes when they are not properly aligned. A sensory motor examination consists of multiple measurements of the ocular alignment positions and may include tests of fusion and binocular (3D) vision.

A sensory motor evaluation detects, assesses, monitors, and/or manages strabismic conditions including esotropia, exotropia, and hypertropia. These conditions can have important visual, developmental, and/or systemic implications. The sensory motor evaluation is necessary to diagnose strabismus, in follow-up to detect improvement or progression in the strabismic condition, and also to determine whether optical correction is affecting the strabismic condition. Information from the sensory motor examination is used to plan medical, optical, and surgical treatments.

As with all special ophthalmologic procedures, this procedure is billed separately from the overall examination.

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What should you know about the refraction?

A refraction is a special procedure that measures the optical properties and focusing power of each eye. Eye drops may be necessary to accomplish these measurements. Together, with a complete ophthalmologic exam, the refraction permits a better understanding of the health of the eye and its vision.

When a refraction is performed, does that always mean glasses are necessary?

Only when indicated for medical or optical treatment, a prescription for corrective lenses is written and given to the parent.

Why is the refraction billed separately?

As with all special ophthalmologic procedures, this procedure is billed separately from the overall examination. Unfortunately, some insurers fail to accept or understand that refractions are a medical necessity in children. Because of this, refractions may be a non-covered service and not paid by your insurance. In this case, you will be personally responsible to pay for this necessary and special part of the total eye evaluation.

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The shape of the eye, or globe, is formed by the cornea (the clear, watch glass cover like front of the eye which we see through), the white sclera (firm shell of the eye), and by the internal fluid pressure maintaining the proper inflation.

Measurement of the intraocular pressure is particularly important when we are concerned that the pressure of the eye is too high. When the pressure of the eye is too high this disease state is called glaucoma. Fortunately, this problem occurs very rarely in children.

There is a very serious disorder we call infantile glaucoma. Infant’s eyes are special since the outermost layers of the eye, the cornea and sclera, are distensible and stretchable until the age of around 3 years.

When an infant has glaucoma the eye is stretched and enlarges faster than occurs during the natural growth and development of the eye. This causes the eye or eyes to appear larger than normal. However, the cornea does not stretch as easily as the sclera. As the cornea stretches too much, the internal membranes leak fluid into the cornea. This initially causes the infant to have teary, watery eyes and significant light sensitivity (photophobia). As the fluid leak increases, the clear cornea becomes hazy or partially opaque. If these symptoms were to occur, immediate Pediatric Ophthalmology evaluation is indicated. Urgent surgical treatment is often required.

When the intraocular pressure measurements are needed in infants and children, examination under anesthesia is almost always required. In older children and teenagers, intraocular pressure measurements are easily accomplished in the office. An anesthetic eyedrops are necessary prior to the measurement because the instrument briefly touches the eye.

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First Visit To A Pediatric Ophthalmologist

What you need to know about their first visit to a Pediatric Ophthalmologist

Before the examination, you will be asked to complete a 2 page questionnaire where you will share what concerns you have about your child’s eyes as well as detailing all of your child’s medical problems, past surgical procedures, medications, and allergies. Dr. Burke will thoroughly review this information with you specifically addressing facts that may impact the child’s eye problem.

Parents are requested to stay with their child throughout the entire examination. Infants and small children are examined while sitting on the parent’s lap while older children are encouraged to sit in the exam chair by themselves.

The examination consists of a vision evaluation (visual fixation ability, age-appropriate and easily recognizable pictures, or alphabet letters), check eye movements and eye muscle alignment, perform an external and microscopic examination of the eye and eyelids, determination of the focusing powers of the eye (refraction), and the evaluation of the inside the eye (retina and optic nerve). When necessary, eyedrops are used to help verify the refraction as well as dilating the pupil allowing an easier view of the structures inside the eye. There is no discomfort from the many instruments and lights that are used during an eye doctor’s evaluation. The only part of the eye examination that may be uncomfortable is the brief stinging the eyedrops cause.

When the examination has been completed, Dr. Burke will discuss his findings and recommendations. All your questions will be thoroughly answered.

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