Since the tear glands have not yet completed their development in newborn babies, there is very little tear production in the first month. Even though babies cry during this period, tears do not shed.
The end of the nasolacrimal duct, which is the last stop of the tear drainage pathway at birth, is closed by a membrane (Hasner's membrane). In the first month, this membrane breaks off from one side and is pulled to the other side and remains as a mucosal clump. This means that this clump functions like a valve (Hasner valve) and prevents intranasal secretions from being directed towards the lacrimal sac. In other words, a situation that allows liquid passage from top to bottom and not from bottom to top is provided. Sometimes Hasner's membrane may not take the form of a valve, break from one side and pull to the other side (not contract). In this case, a picture of Congenital Dacryocystitis develops in infants. These babies constantly shed tears, have burrs, and from time to time, there is swelling, redness and local temperature increase in the lacrimal sac region with an acute dacryocystitis attack.
It is absolutely necessary to give systemic and topical antibiotics to babies brought with acute dacryocystitis. Sometimes it may be necessary to drain the lacrimal sac area where the swelling is present. Even if the acute dacryocystitis attack subsides, the chronic picture will continue because the obstruction continues.
The age of the child is very important in congenital dacryocystitis. In children brought within the first 6 months, nasolacrimal massage (15-20 days) can solve the problem in 70-80% of the cases. However, parents should apply this massage properly as described by the physician. The aim of massage is to create positive pressure in the pouch with the pressure on the pouch and to open the Hasner membrane. Sometimes the 6-month period may have passed, probing is necessary as massage cannot be very beneficial in these children. The trick in probing is to mechanically rupture (perforate) Hasner's membrane with the probe. However, for this procedure, the child must not exceed 12-24 months. Otherwise probing may not work as well. If probing is unsuccessful, it can be repeated a second time, and if the second time is unsuccessful, the third application is not performed. At this stage, children are candidates for dacryocystorhinostomy (DSR) surgery. In DSR applications, it is necessary to open a window from the lacrimal bone. If it is performed before the age of 4-6, Since the development of facial bones has not yet been completed (maxillofacial development), facial asymmetry will occur with facial development. Also, the success rate will decrease. For this reason, children with DCR surgery indication should be expected to exceed this age range. The most ideal is to solve the problem with nasolacrimal massage. In cases where a solution cannot be found, a treatment plan should be planned according to the patient's condition.
Compared to adult patients, everything is more problematic in pediatric patients. The inflammatory response after the procedures is much more exacerbated than in adults. Wound healing responses are much more exaggerated, fibrosis development is much more. In short, they are difficult patients. For this reason, oculoplastic surgeons who know the treatment approaches in congenital dacryocystitis very well, know what to do at which stage, have a good understanding of the anatomy of the pediatric tear ducts, and have extensive surgical experience will be a good decision. It should be noted that some things are irreversible. Our children are very precious.