Dacryocystorhinostomy

[pete02]

Hi everyone, I had a question and was wondering if anyone could help me out. My brother’s little girl is 19 months old and apparently has the tear duct in one of her eyes blocked up. They took her to a specialist and she said there was a membrane covering the duct which was fairly common so she would need to pierce the membrane to allow the eye to drain. The doctor proceeded to pierce the membrane but she said when she did she felt something solid underneath and decided not to mess with it. The doctor gave them some drops to see if that would dissolve whatever is in there but after a few weeks the drops have done nothing. I’m not sure what kind of drops they are or if that even matters but I’m trying to get more info from my brother as I go.

The doctor is now recommending what she calls major surgery. It's called dacryocystorhinostomy. The operation makes a new pathway for the tears to drain into the nose. I briefly read up on it and there are two types, an internal and external procedure. With either of the two procedures though they talk about making incisions and breaking bone to make a new pathway. Maybe its just me but it sounds like a lot for the poor girl and I hate to think she might get traumatized with this operation. I mean I’m sure they’ll knock her out for this but she will most likely be in some pain when she wakes up being that a new hole and tube have been installed in her head. As it is right now it’s not causing any complications other then they have to wipe her eyes when she gets up from sleeping but on the other hand I did read about how this can lead to a constant infection of the eye if not treated and such so my first thoughts were on trying some DMSO with a saline solution to see if it will dissolve the blockage. The doctor says they don’t have to do anything right away and if they wanted to try the prescription solution again they could do that but it didn’t work the first time so I don’t have much faith in it.

So he has asked me if I could get an opinion from the members here. He knows a lot of what we do here from our many conversations and would prefer to try something less invasive than this surgery if at all possible. So I thought I’d ask if anyone had any experience with this sort of thing or any advice on what you think might be best for the child. I am still trying to find out more info from him as I go so if there are any questions I’ll do my best. Any thoughts on the matter are greatly appreciated and thanks for reading.

 

[nicklebleu]

Hi Pete, sorry to hear from your brother's little girl.

I am not very familiar with this topic, so I did a bit of a search on "alternative treatments of epiphora" (= overflow of tears).

I found this article. In it the author says:

DCR surgery should never be the first line of defense in epiphora treatment. In fact, it should never be the second or third, either. It should be dead last in the list. Only when every other method has been utilized exhaustively should such a drastic procedure be considered, and only then after the patient has been fully informed about the how a DCR is performed and what the risks are. Sparing details here is no different from flat-out lying. A lie by omission is still a lie. Lying to patients about the details of a medical procedure is about as unethical as it gets.

He then proceeds to list alternative measures that are designed for adults, but can probably be applied to kids as well. I would absolutely continue to try non-invasive measures as long as it is possible, especially given that she is only 19 months. Maybe she will grow that one out, who knows.

Also a second opinion from another (if possible pediatric) otorhinolaryngologist would be in order, I would say, if you can find one around the area in which you live.

The other thing is to also explore the symbolic content of the symptoms (overflowing tears), as additional means of accessing the problem.

Hope this helps and best wishes to your brother.

 

[Renaissance]

Hey Pete, sorry to hear this. I can imagine your brother, you and your family are pretty concerned about a major surgery for such a young child.

Maybe its just me but it sounds like a lot for the poor girl and I hate to think she might get traumatized with this operation. I mean I’m sure they’ll knock her out for this but she will most likely be in some pain when she wakes up being that a new hole and tube have been installed in her head.

If they're going to knock her out, that would actually concern me more than the procedure itself. I looked up a couple of articles on anesthesia and children and found there have been studies that link anesthetic drugs with an increased risk for learning disabilities and behavioral problems. It seems anesthesia could cause problems for a developing brain. I don't know if it is a long surgery, or how this relates to a case for a child, but higher doses of anesthesia can hang around in the body to be absorbed by the fat cells, which is not good either. Even adults report lots of problems with it's lingering effects. This might have to be weighed with the issue at hand and the need for surgery, but it also sounds as though it might not be an extreme issue that needs to be solved with surgery immediately. I agree with nicklebleu that getting a second opinion would be a good idea.

Here's two articles I found from mainstream sources:

http://www.webmd.com/parenting/baby/news/20120820/anesthesia-may-harm-childrens-brains

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm364078.htm

 

[Arwenn]

Hi Pete,

I'm sorry to hear about your niece. I have worked with ophthalmologists who do DCRs- they usually do them under local and as a day surgery, however because of her age, they will have to put her under. The anesthesia would concern me at her age (& there will be some pain and discomfort after the procedure too), so perhaps seeing a pediatric specialist to get a second or third opinion might be the way to go. Also if it is a very hard mass constricting the duct, I would be wanting to check that out and make sure its nothing nasty. Aside from tears over-flowing, the main problem in not opening up the tear duct, could be possible infection of the tear duct and/or lacrimal sac. Perhaps try warm compresses and DMSO solution in the interim? This website here seemed a good resource for easy to understand information on the topic:

Treatments for blocked tear ducts
There are different treatments for blocked tear ducts. Your doctor will explain which treatment is best for your child.
Medical treatments include massage and antibiotics for any infections. If these do not work, your doctor will recommend surgery (an operation).
Massaging the eye
Gently rubbing (massaging) the lacrimal sac will often help open the tear duct. You will usually need to do this four to six times a day. Your doctor will explain how to massage the lacrimal sac.
Antibiotics
If your child has an infection, the doctor may prescribe antibiotic drops or ointment​. Make sure you apply the ointment or eye drops correctly.
Surgery for blocked tear ducts
If medical treatments have not worked after several months, your child may need surgery. Your child might also need surgery if the lacrimal sac is infected and the skin between the eyeball and the side of the nose is red and swollen.
Different types of surgery are available. Your doctor will discuss with you which surgery is best for your child. This will be based on your child's age and how serious the blockage is. Your doctor will also discuss the risks involved with any surgery.
What happens during tear duct surgery?
Before the surgery, your child will have a special "sleep medicine" called a general anaesthetic. This will make sure your child sleeps through the operation and does not feel any pain.
Three types of surgery are available:
probing and irrigating
silicone tube insertion
dacryocystorhinostomy.
Probing and irrigating
Probing and/or irrigating is the most common surgery for blocked tear ducts.
A thin blunt probe is inserted from the punctum into the lacrimal duct to open the blockage.
A second probe is inserted into the nose to make contact with the first probe and make sure the duct is open.
If the surgoen decides to irrigate (flush) the duct, a blunt needle will be inserted and saline solution (sterile salt water) will be flushed through it.
The needle and probes are removed.
Silicone tube insertion
In this type of surgery, the surgeon puts a thin tube into the lacrimal duct. The tube is left in for a number of weeks to stop the tear duct from blocking again.
Dacryocystorhinostomy
Dacryocystorhinostomy (say: DACK-ree-oh-SISS-toe-rye-NOSS-toe-mee) is surgery to make a new opening in the tear sac and through the bone into the nose. This lets the tears drain into the nose.
All three types of operation are done as day surgery. This means that your child does not stay in the hospital overnight afterwards.

_http://www.aboutkidshealth.ca/en/healthaz/conditionsanddiseases/eyedisorders/pages/blocked-tear-ducts.aspx

 

[Gaby]

Hi Pete, it is a fairly common condition congenital-wise and for the most part it opens up with local measures, i.e. massage and stuff. Surgery, as mentioned, is really the last option and often not necessary. Perhaps the specialist opted for surgery when feeling a little something there that he/she was not familiarized with. I think a second opinion could help clarify. Perhaps an accumulation of debris got solidified (?).

I think DMSO 25% dilution is worth a shot. DMSO has dissolved deposits and stuff. I would make sure your brother and his wife are on board on this one though. DMSO at that concentration can still "burn":

DMSO - The Real Miracle Solution
http://www.sott.net/article/228453-DMSO-The-Real-Miracle-Solution

Perhaps others have a better idea of which is a good remedy to try out.

My 2 cents!

 

[Konstantin]

My son have same problem on pretty same age. He is now 7 years old. But almost 6 years ago he have the same problem. They give him drops, some kind of antibiotic to stop eye infection but with no results.
I solved that problem my way. I dont trust doctors and usually i do litle research to learn as much as possible for the problem and then trying to do some logical actions.
Doctors recommended surgery or punctuation with some special needle of that canal. I refused. My wife was very upset. I started with massage of that spot( from the beginning of the eye duct at the corner of the eye down to the corner of the nose). At the beginning i felt some tiny bump under my finger just at the beginning of the path. I applyed little more pressure during massage but not too much to irritate the skin and make more problems.
ON the moments it was very unpleasant for the children but i managed to make strokes while he was playing with the toys.
Few times a day. After couple of days he was fine. Only side effect was little irritated skin on that place.
So find a good anatomical image of that tear duct so you can visually know from there to where it goes. Then apply pressure and stroke down the channel.
To little pressure will not do the job. Too much pressure with make more problems.
This is how i solve that problem. Maybe i just have luck. Just try it before things like surgery or something like that.

 

[Nancy2feathers]

Hi Pete. Sorry to hear about what your niece is experiencing with her tear duct. I would hold off on surgery and try natural methods first as mentioned. Something that helped me with infection of the eye is colloidal silver. Worked like a charm after using as an eye wash for several weeks daily. I don`t know if it would help in your niece`s case, but it might be worth a try. The massaging sounds good to break up the hard matter that has solidified, along with warm compresses.

 

[pete02]

Thanks everyone for your input and well wishes.

I've spoken with my brother and he's read the responses himself and he feels very much the same, against the operation until other methods have been exhausted. I hadn't even thought about putting a child that young under anesthesia myself but when Ren mentioned it my brother had agreed. He said they put her under for the first step of breaking the membrane and his wife was not very happy about it at all. They keep up with some health topics and try to avoid anything that may seem harmful when it comes to the child like vaccines, fast foods, candy, etc... Thanks for bringing that up btw Ren.

From the feedback so far I've ordered pharma grade DMSO and my brother will get saline solution and a dropper. He's going to speak to his wife about this and go with massaging the lacrimal sac and DMSO drops for now. I'll find some directions on the massaging technique and print them out for her. A warm compress is also a great idea if they can get her to sit still long enough.

DMSO - The Real Miracle Solution
http://www.sott.net/article/228453-DMSO-The-Real-Miracle-Solution

Thanks for this Gaby. I would like to be able to forward this to his wife but her main language is Spanish. Is there a copy of this article on the Spanish Sott site? I tried looking around but had no luck.

Thanks again everyone! With your help my brother feels much more certain that this is something they can take care of themselves. If it should not work for them then they will seek out a second opinion with the understanding that the current doctor has probably never experienced this before and is not sure how to handle it which is most likely the case.

 

[Gaby]

Thanks for this Gaby. I would like to be able to forward this to his wife but her main language is Spanish. Is there a copy of this article on the Spanish Sott site? I tried looking around but had no luck.

It is indeed, thanks to the best translator team in the entire Universe ;)

DMSO: solución milagrosa y un antídoto para el envenenamiento por radiación
http://es.sott.net/article/4995-DMSO-solucion-milagrosa-y-un-antidoto-para-el-envenenamiento-por-radiacion

All the best!