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Dr. Piccirillo is a professor in the Department of Otolaryngology, Head and Neck Surgery, with a wealth of experience in all phases of ear, nose and throat conditions. In his spare time he is a chef, at home.

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Nasal Lacrimal Duct Surgery

About 1 in every 15 infants are born with an unopened tear duct. The bony tear duct is located in the outer wall of the nose and normally drains the tears by way of two tiny tubules located near the inner corner of the eye. 90% of the infants born with an unopened duct will have the duct open on its own by age 6 months. Opening of the duct is sometimes aided by gently pressure applied sideways against the nose at the inner corner of each eye (massage).

A closed duct is evident as sticky matter in the eye or on the eyelashes, overflow tearing, a watery eye or red irritation of the eyelid skin. Severe mattering or skin irritation can be treated by application of a tiny amount of antibiotic ointment at bedtime. Antibiotic ointment is usually only as a temporary treatment; it does not correct the blockage itself.

Tear duct blockage that persists beyond 6-9 months usually causes a chronic infection of the lacrimal sac and some scarring within the sac. For this reason, probing is recommended at about age 6-9 months to permanently open the duct and clear out the accumulated pus. Probing can eliminate the mattering, tearing, and risk of sac scaring.

Tear duct probing is performed as a Same Day procedure in which the child arrives an hour before the procedure and returns home a few hours later. The procedure requires general anesthesia where the infant is completely asleep and feels no discomfort. Probing requires no skin incision or bandaging and involves no pain for the infant.

Smooth microscopic probes are inserted into the lacrimal sac from the eye and nose. A tiny balloon may be inserted, inflated and removed to further open the sac. If cartilage in the wall of the nose is blocking the duct, it is gently moved to keep the duct open.

Complications from this procedure are extremely rare (1 in 1,000 or less). Our pediatric specialists will have carefully considered whether natural correction is taking place or whether treatment using massage or antibiotics would be helpful, before recommending tear duct probing.