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At Children’s Hospital of Pittsburgh of UPMC, we believe parents and guardians can contribute to the success of this procedure and invite you to participate. Please read the following information to learn about the procedure and how you can help.
The nasolacrimal (nay-zo-LACK-cra-mul) duct is part of a system of channels that move your tears through your eye to the back of the nose and throat.
As tears are made, old tears drain from the eye through the upper punctum (PUNK-tum) and lower punctum, the two tiny holes you can see at the corner of the upper and lower eyelids near the nose. The tears then move through channels called the canaliculi (cane-uh-LICK-yoo-lie) and into the lacrimal sac, just inside the bridge of the nose. From the sac, the tears drop down the nasolacrimal (tear) duct, which drains into the back of your nose and throat. This is why your nose runs when you cry. When this system is working right, new tears keep your eyes moist and old tears drain down your throat and are cleared when you swallow.
Sometimes a valve or thin membrane of skin-like tissue inside the nose fails to open before birth and blocks part of the tear drainage system. When babies have a blocked valve, the tears cannot drain properly and start to back up inside the system spilling over the eyelid and onto the cheek. The eyelids can become infected, leading to conjunctivitis (con-JUNK-tiv-eye-tis), commonly called “pink eye,” and sometimes more serious eye conditions.
When a baby has overflowing tears and eye infections, the doctor’s first step is to prescribe antibiotic eye drops or ointment to fight the infection. Parents also can clean the eyelids with a warm washcloth and massage the corner of the eye by the nose. Many times, the combination of antibiotics, warm washcloths and massage will be enough to open a clogged valve. If these treatments do not work, then a probe and irrigation procedure of the nasolacrimal duct may be needed.
Probing of the nasolacrimal duct is done to open the valve between the nasolacrimal duct and the nose. The doctor first dilates (widens the opening) in the puncta (the two little holes in the eyelid) with a tiny metal dilating tool. Then a thin, flexible probe is gently moved through the duct until it reaches the inner nose. Irrigation, or flushing sterile liquid through the duct, is done to make sure the duct is open and the blockage has been removed.
Occasionally, the probing and irrigation procedure will not completely open a valve, or may not keep it open permanently. If that happens, another procedure may be needed to open the nasolacrimal duct.
In the 2 weeks before the procedure, do not give your child any aspirin or ibuprofen. That includes Motrin®, Advil®, Bayer®, Pediaprofen®, Aspergum®, Pepto Bismol® and Alka Seltzer®. Your child may take Tylenol®.
The day before the surgery, do not allow your child to get any kind of vaccination.
When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery. One business day before your child’s surgery, you will receive a phone call from a nurse between the hours of 1 and 9 p.m. (Nurses do not make these calls on weekends or holidays.) Please have paper and a pen ready to write down these important instructions.
For children older than 12 months:
For infants under 12 months:
For all children:
The most important role of a parent or guardian is to help your child stay calm and relaxed before the procedure. The best way to help your child stay calm is for you to stay calm.
A pediatric anesthesiologist—a doctor who specializes in anesthesia for children—will give the medications that will make your child sleep during the test.
Before the procedure, a member of the anesthesia staff will meet with you to take your child’s vital signs, weight and medical history. As the parent or legal guardian, you will be asked to sign a consent form before the anesthesia is given.
This procedure is done through the Same Day Surgery Center at Children’s Hospital in Lawrenceville and at Children’s North in Wexford.
When you check in at the registration desk, you will be asked for the clearance form from your child’s primary care physician (PCP). This PCP form was given to you at the appointment with the ophthalmologist when you scheduled your child’s procedure.
Once your child is registered, you and your child will be called to the examining room.
While your child is asleep, his or her heart rate, blood pressure, temperature and blood oxygen level will be checked continuously.
When your child is moved to the recovery room, you will be called so that you can be there as he or she wakes up. While your child is in recovery, your surgeon will talk to you about the surgery. This is a good time to ask questions about pain medications, diet and activity.
When your child is discharged from the hospital, he or she still might be groggy and should take it easy for the rest of the day.
You will need to bring your child to see the doctor 1-2 weeks after the surgery.
The following symptoms may be cause for concern:
If your child has any of these symptoms, you should call the surgeon’s office at 412-692-8940 immediately. If you are calling during the evening or on a weekend, please call the hospital at 412-692-5325 and ask to page the ophthalmology resident on call.
If your child has any special needs or health issues you feel the doctor needs to know about, please call the Division of Ophthalmology at Children’s before the surgery and ask to speak with a nurse. It is important to notify us in advance about any special needs your child might have.
Division of Ophthalmology
Children’s Hospital of Pittsburgh of UPMC
One Children’s Hospital Drive
4401 Penn Ave.
Pittsburgh, PA 15201
412-692-5325 evenings and weekends
2599 Wexford Bayne Road
Sewickley, PA 15143
724-933-3600 Medical Appointments
724-933-3700 Surgical Appointments
Children's Hospital's main campus is located in the Lawrenceville neighborhood. Our main hospital address is:
Children’s Hospital of Pittsburgh of UPMC
One Children’s Hospital Way
4401 Penn Ave.
Pittsburgh, PA 15224
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