Blocked Tear Ducts: Probing Procedures

Topic Overview

Probing is a procedure that is sometimes used to clear or open a blocked tear duct. The doctor inserts a surgical probe into the opening (punctum) of the tear duct to clear the blockage. Afterward, he or she may insert into the duct a tiny tube with water running through it. The water contains a fluorescein dye. If the doctor sees that dye has moved into the nasal cavity, he or she will know that probing worked. Often after probing, antibiotic eyedrops are used 4 times a day for 1 week.

Probing is rarely used as treatment for adults with a blocked tear duct. Probing is most often used when a baby:

• Is between 6 months and 13 months of age. Most blocked tear ducts open up on their own by 12 months of age.
• Has persistent tear duct infections and excessive tearing.
• Has a fully blocked duct. Partially blocked tear ducts often clear on their own by the time a child is 4 or 5 years old.
• Develops a bluish bulging area along the side of the nose (dacryocystocele).
• Becomes more and more irritable because of the blockage.

Probing can be done using local or general anesthesia depending on:

• Your baby's age. The older the child is, the more likely that the doctor will suggest general anesthesia.
• How well your baby tolerates pain. Even though local anesthesia is usually given in the form of eyedrops, your baby may feel some pain. With general anesthesia, no pain is felt during the procedure, which lowers the overall stress for some children.
• Your comfort level with the risks of anesthesia. With local anesthesia, the procedure can be done in a doctor's office, and your child can go home soon after the procedure is finished. Probing using general anesthesia has a longer recovery time. Usually a baby will need to stay in the hospital for 1 to 3 hours after the procedure. Side effects, such as nausea, may also occur. Also, general anesthesia carries a slight risk for serious side effects.
• Whether an additional procedure may need to be done at the same time. If probing is done using general anesthesia, the surgeon is able to more thoroughly evaluate the duct and find out whether another procedure is needed to clear the blockage. Often, if another procedure is needed, it can be done at the same time, avoiding the need for a separate procedure in the future.

Talk to your doctor about the pros and cons of the different types of anesthesia.

Probing successfully opens the duct for about 80 out of 100 babies who have blocked ducts.^{footnote 1} Probing may be done again if it doesn't work the first time. Most children under the age of 4 who have a simple blockage of a tear duct can be helped by a single probing.

There is a rare risk of scarring.

The symptoms of a blocked tear duct may return for a short time if your child gets an upper respiratory infection, such as a sinus infection or a cold. If symptoms persist, a dye solution may be used in the eye to check the drainage system. Massage and antibiotics may be used for 4 to 6 more weeks. If excessive tearing continues, the probing may be repeated, but usually not for at least 3 months after the first procedure. Other treatments may also be tried, especially if more than one probing is done without results.