Lacricath balloon dilation is a procedure used to treat tear duct obstructions that do not clear with probing and irrigation. It is also used for older children with tear duct blockage. During this procedure, a balloon probe is used to clear the obstruction. The balloon is then deflated and the catheter is removed. Often, the area where the tear duct opens into the nose is enlarged by a procedure called "infracture of the turbinate." Near the end of the procedure, fluid is irrigated through the tear duct. This shows us that the tear duct is draining properly.
Lacricath requires general anesthesia and takes approximately 30 minutes to perform. The patient is generally ready to go home within a few hours after the procedure. There are no bandages and there is no pain. There may be a small amount of blood in the tears or from the nose following the procedure, but this is usually minor. It will not be necessary to limit your child’s activities following the procedure.
As a normal routine, we ask that you take your child to see his or her pediatric eye care doctor within two days of the procedure to make sure that your child is healthy enough for general anesthesia. In addition to this, a pre-op appointment will be made for you and your child at Thomas Eye Group to check your child and to answer any remaining questions that you may have. In some cases, parents may also be asked to bring their child in for a blood test prior to the procedure. Our surgery coordinator will schedule your child’s surgery and will review your child’s preop instructions with you. She will give you written instructions specific to your child's needs.
Eye drops will be prescribed for use for three days before the procedure and for 5 days after the procedure. An information sheet will be given to you at the hospital with instructions on the care your child will need the following surgery.
If you have any additional questions, please call us at any of our convenient locations in Atlanta, Sandy Springs and all across Georgia. You may also want to jot them down so that you can review them with the pediatric eye care specialist at the time of your preop visit. We look forward to taking care of your child.
Tear duct obstruction is a very common problem in infants and frequently, within the first five or six months of life, it clears up on its own. The tear system in our eyes is like a shower system. Each eye has a tear gland that is continually making tears, even when we are not crying, and a tear duct (or drain pipe) to drain tears out of the eyes and into the nose. (This is why we get a runny nose when we cry.) Some children are born with a blockage at the bottom of the tear duct and the result is similar to what happens when a shower drain is blocked. When we examine these children, we see a thin rim of water in the eye, and tears running down their cheek even when they are not crying. Because the tears do not flush properly, these children may get recurrent infections with yellow or green discharge in the corner of the eye.
If a child's tear ducts do not clear up on their own by seven or eight months of age, typically we would unplug the drain system. Otherwise, due to recurring infections, there is a risk of developing scars within the drainpipe itself. At this point, we recommend that they have a relatively simple operation called a probing and irrigation of the tear duct system. A fine probe is passed down through the system and breaks through the obstruction, after which the system is irrigated and any pus or discharge is flushed out. This is done in the hospital on an outpatient basis, under light anesthesia.
Although the success rate of a tear duct probe is over 90 percent, occasionally a child will require a second tear duct procedure.
Nasolacrimal duct obstruction in children means that the draining system responsible for removing tears from the surface of the eye is clogged. Many children have this problem successfully treated with a procedure called nasolacrimal duct probe and irrigation. A few children continue to have tearing after a nasolacrimal duct probe and irrigation. A time-tested alternative for these children is called nasolacrimal duct probe and intubation, otherwise known as a Crawford tube. It is performed under general anesthesia and takes approximately 30 minutes. A probe is used to open up the clogged area in the tear duct. After the opening is made in the tear duct, then a thin tube is placed through the opening and remains there for approximately 6 months. This allows the duct to remain open and not seal shut. Occasionally the tube can become displaced and require repositioning. Nasolacrimal duct probe with intubation (Crawford tube) is usually combined with infracture of the inferior turbinate. The inferior turbinate is a cartilaginous structure made of cartilage inside the nose that can sometimes block the opening of the tear duct. This is gently moved away from the tear duct system so that it does not block the normal flow of tears. Following surgery, the children have little or no discomfort from this procedure and resume their normal activities within 1 or 2 days. The Crawford tube is not a drain tube. Children can have tearing when the tube is in place and may get occasional mucous to be gone when the tube is removed. The tube is visible at the corner of the eyelid. It is removed six months later in the operating room.
This is a highly effective method to treat young children who continue to tear following a nasolacrimal duct probe and irrigation and in older children who have had no previous tear duct procedures. Crawford tube placement is one of several procedures that are available and its success rate is approximately 90%.
You can feel comfortable that after your child has had the tube removed there is a high likelihood of permanent resolution of tearing.