On the list of “Things No Parent Wants” you can safely put having your child undergo surgery. Still, sometimes surgery may be the only option to successfully correct a health problem and give your child the best shot for a bright future.
Some children, for example, are burdened with eyelid, tear drain system or eye socket problems. This may be due to a congenital birth defect, infection, tumor or traumatic injury.
Oculoplastic surgery – a surgical specialty dealing with eyelids, tear ducts, and the eye socket – may be needed when non-surgical therapies have been exhausted. If your child requires pediatric oculoplastic surgery, find solace in knowing that the surgeons at SightMD have the decades of experience needed to perform optimally safe and effective procedures.
Depending on the specifics of your situation, oculoplastic surgery can improve your child’s vision, avoid health complications or remove cosmetic blemishes around the eyes for enhanced wellbeing and self-esteem. While any number of abnormalities can create the need for oculoplastic surgery, the most common conditions are tear duct obstructions, dermoids and chalazions.
5% of all babies are affected by blocked tear ducks
*American Association for Pediatric Ophthalmology and Strabismus (AAPOS)
Tear Duct Obstruction
Many infants are born with an underdeveloped tear-duct system, potentially causing excessive tearing, infection and tear-duct blockage.
Blocked tear ducts affect about 5% of all babies, according to the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). The good news is that the vast majority of the cases – about 90% – resolve with little to no therapy by the child’s first birthday.
The Basics on Tear Ducts
Our eyelids and lashes help keep our eyes moist and protect our eyes from the dust, bacteria, and other pollutants we are exposed to on a daily basis.
To aid with eye moisture, there is also a protective system of glands and ducts, called the lacrimal system. The lacrimal glands produce tears, while the small glands at the edge of the eyelids make an oily film that prevents your natural eye lubricant from evaporating.
Tears drain out of the eyes via the lacrimal canals that are located on your eyes’ upper and lower lids. From there, tears pass into the lacrimal sac, located in the inner corner of the eyes. Finally, the tears move down via the nasolacrimal duct and drain into the back of the nose. The nasolacrimal duct is typically the culprit when babies experience tear-duct blockage.
Causes of Blocked Tear Ducts
The most common cause of tear duct blockage is congenital nasolacrimal duct obstruction, or when a baby is born without a fully developed nasolacrimal duct. Generally, this involves a duct that is too narrow or a web of tissue blocking the duct. Rarer causes of blockage may be nasal polyps or trauma to the eye area.
Signs of Blocked Tear Ducts
A blockage in the drainage system causes excessive tearing, and typically occurs within the first weeks of life – as in cases of congenital nasolacrimal duct obstruction.
Eyelids may also become inflamed, swollen and red, and a yellow-green discharge may emit from the eye.
Diagnosis & Treatment
Tearing and discharge during the first several weeks of life is a strong indication that your child has a blocked tear duct.
If you notice these symptoms in your little one, reach out to your pediatric ophthalmologist, who can perform tests to confirm the diagnosis. Blocked duct symptoms can be similar to other disease symptoms – like glaucoma – and seeing an eye specialist is the only sure way to get an accurate diagnosis and treatment regimen. When obstruction does not resolve on its own and non-surgical treatments have failed, an operation may be recommended by your doctor. Surgery for tear duct blockage is usually performed on babies who have a serious infection, repeated infections or excessive tearing after about 6 months of age.
Tear duct blockage surgical procedures include:
- Tear duct probing – Most children who need surgery will undergo a tear duct probing procedure. It takes about 15 minutes and involves a smooth probe (that looks like a wire) being guided through the tear duct and into the nose. Probes of larger diameters can be inserted to widen the tear duct system and free up the blockage.
- Silicone tube intubation – This method involves placing silicone tubes in the tear ducts to stretch them out. The tubes are left in for up to 6 months and then removed during another quick procedure.
- Balloon catheter dilation (BCP) – Like the other two blockage procedures, this one works by expanding the tear ducts to eliminate the blockage. In this case, a balloon is inserted into the tear duct through an opening in the corner of the eye. The balloon is inflated so the tear duct expands. Once the blockage is eliminated, the balloon is deflated and taken out.
These procedures are typically short and performed on an outpatient basis. They do require a child to be put under anesthesia.
Some children experience non-cancerous tissue growth in the orbital region of the eye, known as dermoids or cysts. There are two main dermoid types that occur on or around the eyes: epibulbar and orbital.
Epibulbar dermoid are located on the surface of the eye, and tend to be firm and white-yellow or pinkish in color. They are not attached to the eyeball itself, but to the conjunctiva that covers the eye. Epibulbar dermoids can be just a few millimeters to over a centimeter in size. They are usually found on one eye, rather than both.
Patients may have local irritation to the eye. More often than not, symptoms are limited to visible cosmetic flaws – the fact that you can see them on the eye. Surgery is not usually performed, but can be an option for improved cosmetic results. Excising the dermoid involves stripping it from the conjunctiva and removing the portion of the mass on the front part of the eye during a relatively short procedure.
An orbital dermoid is a bump, often egg-shaped, that rises from under the skin adjacent to eye socket. Treatment will depend on location, size and involvement of orbital structures. In many cases, the dermoid is simply a cosmetic deviation that can vary from being hardly noticeable to very evident.
At a certain point, the dermoid can become so big that it poses a risk of rupturing and causing an inflammatory reaction. Dermoids can also inhibit eye movement, and rarely, can cause vision loss in the affected eye. For these reasons, a pediatric ophthalmologist may recommend the surgical removal of the dermoid.
To excise an orbital dermoid, the skin over it is opened and the adjacent tissues are dissected to reveal the dermoid. The cyst is then carefully cut free from the surrounding tissue. The length of the procedure and the tissues affected will vary from case to case, depending on the cyst size, location and surrounding tissues involved.
A chalazion is a lump that gradually forms along the eyelid due to the blockage and swelling of an oil gland. Unlike a stye, a chalazion is not caused by infection in the glands. Chalazion also differ from styes in that they tend to be larger and further from edge of the eyelid.
A chalazion usually begins as a tiny, tender and red area on the eyelid. It can grow to a painless lump as big as a pea in less than a week. Most of the time, a chalazion will clear up by itself in less than a month. Patients can facilitate the drainage process of the chalazion by gently massaging the eyelid or applying a warm compress.
Less commonly, a chalazion can persist for several weeks, growing large enough to be cosmetically unappealing. Substantial chalazion can actually press on the cornea, creating a temporary irregularity on the surface of the eye and causing blurry vision. A chalazion that is cosmetically or visually hindering a patient may require a simple in-office surgery. An ophthalmologist will apply a local anesthesia and then make a tiny incision, usually underneath the eyelid to excise the chalazion without visible scarring.