Monday, October 29

Tear ducts - Blocked tear ducts in newborn - Dacryostenosis

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Tear ducts in newborns are quite often under developed or clogged at the time of birth. In most of the newborns, these blocked ducts open up after several weeks and the natural drainage of lacrimal fluids is established.

Tears are secretions by lacrimal gland, meibomian glands (or tarsal glands) and conjunctival goblet cells in the eyes. Tears are for cleaning, protecting, moisturizing and lubricating the eyes. Production of tears is a continuous process and newborns also have functional lacrimation.
When we blink these secretions are smeared on the eye and the excess is pushed towards the tear ducts in the inner corners of the eyes. There, these secretions get collected in the nasolacrimal sac and are emptied into nose through nasolacrimal tubes.

Causes of blocked tear ducts in newborns

As the lacrimation is a continuous process, the excess fluids have to find a way out and it is usually through the tear ducts. About 20-30% of the newborns have blocked or under developed tear drain ducts.

The condition of blocked tear drain tubes at birth is known as congenital nasolacrimal duct obstruction (congenital dacryostenosis). This condition can affect just one eye or both and in most of the cases it is due to a small thin membrane obstructing the opening. With the growth of the youngster there is spontaneous natural remission of the blocked condition in about 9-12 months in 90% of the cases.

In the case of under developed nasolacrimal tubules, with the growth of youngster, the nasolacrimal tubes also extend and grow to establish connection with the nasal cavity.

Certain other blocked conditions are encountered in a few newborns. They may occur in the following situations.
  • Blocked lacrimal gland or nasolacrimal tube due to infections.
  • Injuries to bone and tissues around the nasolacrimal tube.
  • Thickening or inflammation of the nasolacrimal tube lining.
  • Inflammation of the nasal cavity lining.
  • Sinusitis.
  • Conjunctivitis.
  • Polyps and tumors in the nasal cavity.
  • Abnormal growth of nasal bone putting pressure on the nasolacrimal tube.
  • Closed, undeveloped or undeveloped holes (puncta) in the inner corners of the eyes.

Symptoms of blocked tear ducts in newborns

If the nasolacrimal tubule is not fully developed, not yet connected or blocked the excess fluid make the eyes appear flooded and newborn tears may trickle down the cheeks. This may happen even when the s/he is not crying. In the first four weeks as the secretions are minimal, flooding of eyes may not be apparent.

Crusty eyes and sticky and matted eyelashes are tell-tale signs of blocked tear ducts. Mucin produced by the glands gets deposited at the corner of the eyes and also makes the eyelids sticky. Bacteria start growing on these deposits and cause eye infection leading to irritation and reddening of the eyes. The stagnated tears in the nasolacrimal sacs may also become a focal point for bacterial growth and lead to swollen sacs. Infection of nasolacrimal sac is known as dacryocystitis. Fever with tenderness and swelling near the nose bridge on the affected side may be experienced.

Remedies for blocked tear ducts in newborns

Usually the conditions with blocked tear ducts do not require treatment as in most of the cases they open up by their first birthday.
However they must be continuously Observed with no intervention to avoid possibilities of complications.
The pediatrician may advise nasolacrimal massage to be repeated a number times in a day.
The pediatrician may also advise cleaning the discharge and crust with clean, soft, wet and warm cloth.
If infection is suspected, antibiotic eye drops may be prescribed.
If the infection spreads and involves nasolacrimal sacs or conjunctiva, oral antibiotics may also be prescribed.
If the blocked condition persists beyond nine months, pediatric ophthalmologist may resort to probing procedure for clearing and opening up tear drain tubes.
Surgical procedures may be resorted to, if there are structural anomalies or abnormal growths.

As there are possibilities of medical complications in blocked tear duct in newborns, it is necessary that if you suspect this condition, bring it to the notice of your pediatrician for medical evaluation.

Related topics in Daily Health News & Tips:
Newborn tears.

Sunday, October 28

Newborn tears - Newborns usually do not shed tears while crying

Home > Newborn tears
A newborn rarely sheds tears while crying. The nervous control and emotional responses in the newborn are still under development. However the basal tears production is functional in newborns to keep the eyes functioning properly.

Crying by newborns is the only way of telling that they are hungry, uncomfortable, sleepy, feeling cold or bored. Crying is the only way to communicate their myriad of problems.

After a few months of growth, with the development of the emotional responses and nervous control, they start shedding tears (lacrimation) while crying. To understand its physiology, we have to know the types of these eye secretions and the process of their formation.
What are tears?
They are secretions from lacrimal gland, meibomian glands (or tarsal glands) and conjunctival goblet cells found in the eyes. Lacrimal gland secrete aqueous lacrimal fluid containing water, lipocalin, lactoferrin, lysozyme and lacritin. Meibomian glands secrete lipids and oils. Conjunctival goblet cells secrete mucin. Lacrimal secretions are produced continuously. With the blinking of eye, lacrimal fluid is spread over the eye surface.

Types of lacrimation
Lacrimation in humans, including newborns, is to clean, moisturize and lubricate eyes. There are three types of lacrimations namely basal, reflex and psychic lacrimation. The lacrimal gland is mainly responsible for producing emotional or reflexive lacrimation.

Basal tears in newborn

In newborns, basal lacrimal production is functional, to keep the eyes moist, clean, lubricated and protected from bacteria. Lysozyme present in the lacrimal fluid helps in the destruction of certain bacteria. If s/he has crusted or sticky eyelids it is an indication of eye infection. Up to one ml of lacrimal fluid is secreted in twenty four hours. With old age the amount secreted may come down.

Reflex tears in newborn

Reflex lacrimal secretion results from irritation of the eyes by any foreign objects. The presence of any irritating fumes or vapors in the atmosphere may also induce the lacrimal secretion. Bright light and hot or peppery taste also induces reflex secretion in the eyes. Certain reflex functions like yawning, coughing and vomiting may also induce lacrimal secretions. In a newborn reflex lacrimal secretion due to all the above mentioned causes is present.

Psychic tears in newborn

Emotional and physical stress like anger, hurt feeling, mourning and pain and intense spasmodic cramps can increase the lacrimation and maintain a copious flow. Limbic system controls  the basic emotional drives and via autonomic parasympathetic nervous system it controls the lacrimal glands. As the emotions and the connected nervous controls are still under development in a newborn, copious flow of psychic lacrimation is absent and hence s/he does not weep while crying.

Newborn lacrimation problems
If a youngster, having started shedding lacrimal fluid while crying, persistently cries without lacrimal fluid with reddened eyes, it could be a sign of something more serious, like eye infection, problem with the function of lacrimal gland or dehydration.
If the eyes are watering without actual crying, it is the problem of blocked or infected nasolacrimal ducts.
An eye specialist will be able to evaluate the situation. If the blockage is due to infection, he may prescribe antibiotic drops.
In newborns, tears ducts blocking is common and in most of the cases the ducts open up naturally after a few months.


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Newborn tears - Newborns rarely shed tears while crying.

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