Syringe and Probing of the nasolacrimal (tear) ducts

Brief description: 

• This procedure is used for unblocking the nasolacrimal (tear) ducts in children. A very fine, flexible wire is passed down one or both tear ducts to remove the blockage.
• Here, we explain some of the aims, benefits, risks and alternatives to this procedure. We want you to be informed about your choices to help you to be fully involved in making any decisions.
• Please ask about anything you do not fully understand or wish to have explained in more detail.
• If you would like this information in another format or language or would like help completing the form, please ask a member of our staff.
• Remember, you can change your mind about having the procedure at any time.

About syringe and probing of the nasolacrimal (tear) ducts 

Blocked tear ducts are a fairly common problem in children and cause watery, sticky eyes. Although the symptoms resolve before the age of one in 85% of cases, some children continue to have sticky eyes and require surgical treatment to clear the blockage. This procedure takes 5 to 10 minutes and involves passing a very fine, flexible wire down one or both tear ducts to overcome the blockage and then flushing the duct(s) to ensure that the duct(s) are patent (free flowing).

Intended benefits of the procedure 

• Syringing and probing is successful in 95% of cases that are caused by a simple duct blockage. The watering and stickiness usually resolve within a week of the procedure. Sometimes the tear duct has a more complicated type of obstruction, and sometimes the duct might not have developed properly. These problems become apparent at the time of the probing procedure and usually require a more complex procedure. Your doctor will discuss this with you after the procedure.

Alternative procedures that are available 

• Simple massaging of the tear duct(s) can sometimes overcome the obstruction in the tear duct. In general, this is more successful in infants under the age of one year. Some surgeons, especially in the USA, probe the ducts of young babies (less than six months of age) without an anaesthetic in their outpatient departments. We do not favour this approach in the UK because many blockages of tear ducts in young babies will resolve anyway if they are left alone.

Before your child’s procedure

• You and your child will have been placed on the waiting list for this procedure by an ophthalmologist (eye doctor) who will have discussed with you the planned surgery.
• We shall ask you for details of your child’s medical history and carry out any necessary clinical examinations and investigations. Please inform the doctor if your child has had any recent health problems, and discuss any questions regarding the surgery that you might have.
• You will be asked if your child is taking any tablets or other types of medication – these might be ones prescribed by a doctor or bought over the counter in a pharmacy. It helps us if you bring details with you of anything your child is taking (for example: bring the packaging with you).
• This procedure involves the use of general anaesthesia, which means that your child will not be conscious during the surgery. See below for further details about the types of anaesthesia we shall use.
• Syringe and probing are usually performed as a day-case procedure but, if your child has other medical problems, a bed in ward F3 might have been arranged.
• If to your knowledge the answer to any of the following is yes, it is important that you tell us. Has your child ever

– received Human Growth Hormone

– or has anyone in your family been diagnosed with CJD

A positive answer will not stop any treatment, it will however allow us to plan your operation so as to minimise any risks.

Fasting before surgery

• Please ensure that your child has plenty to eat and drink the day before surgery. If your child is very young, you might like to wake them in the evening for an extra drink. It is very important that your child’s stomach is empty before they undergo a general anaesthetic. Your child must stop eating (this includes formula baby milk, chewing gum, sucking hard boiled sweets and drinking milk and fruit juice) for four hours before their anaesthetic. Breast fed children may have their last feed three hours before their anaesthetic and all children must not drink anything for three hours before their anaesthetic.

On the day of the surgery

Please arrive at the allotted time for the surgery. If you are unwell please do not accompany your child onto the ward.  Upon your arrival the nurses need to complete admission paperwork about your child and family.  You will be required to complete a consent form. Your child’s legal guardian, a person with parental responsibility, will be asked to sign the consent form. 

The nurse will record your child’s weight, check your child’s temperature, pulse rate, breathing rate and any other observations that are necessary. These are important measurements to ensure that your child is fit and healthy prior to undergoing any procedure. 

Your doctor will be informed of your arrival and they will come to meet you in order to answer any further questions

Your child will also see an anaesthetist who will fully explain everything to you regarding your child’s general anaesthetic. This will give you the opportunity to ask questions about the procedure.  There will be a little wait while all of the children are assessed.

Please bring a small toy with you, a quiet activity, such as a book or magazine for example, to help to distract your child and pass the time while they are waiting. When your child’s nursing team, surgical team and anaesthetist have assessed all children on the theatre list and confirmed that they are fit for theatre, if you so desire, you can be provided with a rough estimate of when you child’s procedure will be taking place. 

When your child’s allocated theatre slot is ready, the anaesthetist’s assistant will arrive to collect your child and take him/her to theatre. A maximum of two parents are allowed with your child to comfort him/her whilst the anaesthetic is administered. A member of theatre staff will then take you to the ward area where you will be shown to the bed space that has been allocated for your child’s postoperative care. This provides you with an allocated space in which to wait for your child and also allows you the opportunity to be able to have something to eat and drink whilst your child is in theatre. You will then be invited into the recovery area when your child’s recovery nurse considers it appropriate for you to be present. The paediatric recovery staff will try to call you to recovery prior to your child waking, however this is not always possible and your child may already be awake by the time you arrive in recovery. Your child may be very sleepy when you first see them, or a little disorientated and tearful. Both reactions are completely normal. 

 Your child might have an oxygen mask on his/her face to help him/her breathe.  After this procedure, your child will have a small, plastic tube in one of the veins of his/her arm. This is called a cannula and is left in place in case your child requires any medication that they are unable to take in their mouth. 

Upon return to the ward, close observation will be made of your child. The nursing staff can give your child painkillers if they are needed.

Discharge can occur and your child’s cannula can be removed once they have had a drink, eaten (without vomiting), passed urine, is comfortable and is back to their usual self, mobilising and communicating appropriately. 

We strongly encourage all children to spend at least the first 4 hours with us following their general anaesthetic prior to their discharge.

During the procedure (operation/treatment) itself

• Before your child’s procedure, s/he will be given the necessary anaesthetic – see below for details of this and the role of the anaesthetist in your child’s care.
• While your child is asleep with the general anaesthetic, the tear duct(s) are syringed with a salt solution to find the blockage. Then a fine wire is passed down the tear duct from its opening on the lower lid margin next to the nose. During this probing, the blockage is cleared. Finally, an orange-stained salt-water solution is flushed through the duct. Following this, we look for this orange dye in the nose to ensure that the tear duct is now functioning normally.

After the procedure 

• Eating and drinking: When your child is fully awake, they will be encouraged to drink and eat. We provide a snack box for your child. The snack box usually includes a sandwich, crisps, cake, yoghurt and juice
• When you can leave hospital: Parents are expected to provide transport on discharge home. The use of a bus may not be appropriate. Your child is undergoing a planned surgical procedure; it would be helpful if you ensure that you have sufficient supplies of simple painkillers such as Paracetamol and Ibuprofen at home, in anticipation of some minor discomfort. 

You should plan for your child to spend at least half a day in Angel Eyes Lasik Centre. This is an estimated average length of stay; please bear this in mind when planning your day.

• When your child can resume normal activities including nursery: Your child should be well enough to resume their normal routine (including swimming) from the day after surgery.
• Check-ups and results. Before leaving hospital, you should be given:

1. Instructions and Prescription of medicines to be taken after the procedure.
2. A follow-up appointment should be usually made.

• For several hours following surgery, it is common to see some blood, or orange-dye stained tears and blood, or (orange/yellow) dye-stained discharge from the nose.

Serious or frequently occurring risks

• Syringing and probing is a very safe procedure, but occasional nose bleeds can occur up to three days following surgery.
• More complicated obstructions (found in 5% of cases) might require further surgery, such as the insertion of a silicone tube in the tear duct, or a surgical procedure to make a new drainage system.

Children’s anaesthesia

Children may need anaesthetics for operations, just like adults. These days, children usually come into hospital on the same day as the operation, unless it is major, and usually do not have premeds. They are seen with their parents by their anaesthetist and usually have local anaesthetic cream put on their hands at this point.    

Many anaesthetists start the anaesthetic with an injection into a vein, and with the local anaesthetic cream this usually does not hurt, or not very much. Others prefer to use gas, and most will use gas if there is a particular fear of needles. 

Usually pain can be controlled by use of local anaesthesia to wounds, followed by paracetamol syrup of something similar. Discuss this with your anaesthetist at the pre-operative assessment. 

We encourage children to rest following their general anaesthetic. Due to this fact please be mind full to ensure that mobile phones are switched off for the duration of your child’s time with.