Treatment of drainage NLD in children

In young children, a large number of children have this duct blocked. The main reason for this closure is that the development of this duct is still incomplete, and as it grows, the duct becomes complete and opens automatically, just as the rest of the organs complete. These children do not need any surgery. During this time watering may occur off and on from their eyes but it does no harm. The age of automatic recovery is one year. If this duct does not open for a year, then it will never open automatically. An operation is required to open it.

• Many children get an infection of the tear sac, which also causes discharge from the eye. Therefore, if discharge also starts, then it is necessary to use medicine in such a condition to treat the inflammation is and also to prevent it from becoming chronic.
• If there is chronic inflammation inside the sac and it does not heal with medication, it is better not to wait until one year of age. And the operation should be done earlier.
• In most of these children, the problem is solved by a small operation called Probing.
• If this does not solve the problem, then a major operation i.e. silicon stent implantation is necessary. And often a tube is inserted through an operation that is removed several months later.

Treatment of NLD blockage in older people

Treatment for older people varies according to the nature of the disease. Some of the cases are described below:

• A large number of people are cured by the use of medicine alone.
• Many people have obstructions in the early parts of the lacrimal pssage, such as as a result of a stroke or other forms of paralysis. Their eye pumping system is affected. Or the mouth of the draining punctum starts to stay away from the eye the condition is called ectropion. In these cases the removal of the relevant cause stops the watering. Most of these are treated with surgery.
• A large number of people who have a blocked canal also have a small operation called Probing.
• For those whose problems have not been resolved in these ways, a major operation (DCR) is needed.

Is watering the only symptoms of a malfunction in the drainage system or is there any other accociated symptom also?

When there is a defect in the drainage system, then various symptoms can occur, depending on the nature of the defect. Some of them are mentioned below:

• If the path is blocked or the water pumping system is weakened, then the water starts flowing to the face instead of going into the nose.
• But if there is an infection in the lacrimal sac or any other part of the tract, then dirty material also starts to form and the eyelids start to stick together.
• In this case, if you press it on the nose near the eye, pus-like material comes out.
• Many times there is a bulge on the nose near the eye which is also called a tumour. This tumour is sometimes painfull. When you press it, pus may come out. This condition often causes a fever.
• This abscess erupts in some people. When it is constantly present and explodes again and again, it is called a fistula.

Why some eyes have problem of watering?

An important cause of watery eyes is inflammation of any part of the eye such as conjunctivitis, keratitis, uveitis etc.

But another reason is a defect in the system that keeps the outer parts of the eye moist and clean. After supplying nutrients and cleaning the outer parts of the eye, the excess fluid drains into the nose. For many, this drainage system undergo disorder. Such people usually do not have inflammation but the fluid keeps on flowing. In fact, it cannot enter into the nose, so it starts to flow out towards the face. Why does it fail because its drainage route have been blocked?

What are the drainage channels where surplus fluid is drained after eye cleaning and how does this system work?

Allah Almighty has created a wonderful system for cleaning and protecting the outer parts of the eye. Some glands which are called lacrimal glands produce a water-like fluid. The two lacrimal glands are right and left below the eyelids and the rest are small glands which are located inside the conjunctiva, the protective membrane of the eye. The fluid from these glands cleanses the eye and keeps the surface of the eye moist. After being used and evaporated, much of the fluid drains into the nose. This fluid also takes the form of tears. The system that connects and drains the eye and nose is called the lacrimal drainage system. You can see its components in the pictures below:

This picture some artist has tried to so show the close relationship between the eye and the nose. This patient’s eye may have been removed due to cancer. However, now there is so much gap between the nose and the eye that the finger is passing. In the same way in silicone stent surgery and DCR surgery the communication of eye with the nose is restored. Silicone stent reopens the natural way in operation. In the DCR operation, an alternative route is created. This results into drainage of the water to flow from the eye to the nose again. However, this artificial route is never equal to the natural path. There is risk of some problems and complications. The biggest problem is that in many patients this pathway closes again over time. That is, the chances of failure in this operation are very high.

In these patients, since the drainage duct is blocked, so in this operation an alternative route is craeted for drainage by breaking the bone. Below are some scenes from this operation