At Sydney Eye Surgeons, we have highly trained Paediatric Ophthalmologists who will provide the best care for your child.
Our Paediatric Ophthalmologists have extensive subspecialty training in all aspects of Paediatric Ophthalmology, including neonatal care, premature babies, early childhood vision disorders, paediatric cataract, lacrimal obstruction, juvenile uveitis and genetic disorders.
For any paediatric ophthalmology referrals, please call 02 9387 4427 to make an appointment with Dr Nisha Sachdev.
Appointments are available at Bondi Junction only.
The eye care of children is of prime importance not only for visual development but also for general development of a child. It has been well recognized that vision is equally important for the development of the child and, indeed, of prime importance for other senses to develop.
In essence, any condition that affects adults can affect a child. However, there are certain conditions that are specific for children. In the simplest form, most children that have “eye issues” may just require spectacles.
If your child has been prescribed spectacles, there will be guidance as to when and how often your child requires these to be worn. Many children can “grow out” of glasses, however, this is not always the case. As your child grows, the eyeball changes shape, which may alter their refraction and require new spectacles lenses. The refraction (or glasses requirement) of a child is usually assessed on an annual basis. This requires drops to be inserted for a comprehensive assessment.
Usually, contact lenses are not suited for children, however, this can be discussed with your Ophthalmologist and can be prescribed in certain circumstances.
Congenital Nasolacrimal Duct Obstruction (CNLDO) occurs when the tear duct (nasolacrimal duct) has failed to open at birth. This happens in approximately 70% of healthy newborns, mostly within the first month of life. However, in 5% of newborns, the duct fails to completely open by 12 months of age, most commonly due to the presence of a membrane at the bottom end of the duct.
The information below relates to persistent Nasolacrimal Duct Obstruction (CLNDO) that is clinically significant after 12 months of life.
There is no genetic basis to this condition.
Anatomy of the tear duct
Tears are produced by the main and accessory lacrimal glands situated under the outer part of the upper eyelid. Tears are drained out of the eyeball through the inner aspect of the eyelids – through small holes called punctae. This forms the initial “top” end of the nasolacrimal duct. The duct continues to drain into the back of the nose. (see diagrams). CNLDO occurs when a membrane obstructs the bottom end of the duct, inducing blockage of the tear duct and hence a watery eye.
Signs and symptoms
Infants with CNLDO present with a persistent watery eye (or eyes), sometimes with mucous discharge (yellowish-green). Most infants become symptomatic during the first month of life. The periocular skin (skin surrounding the eyeball) can become chapped or dry due to continual exposure to tears and excessive wiping of these tears. Recurrent conjunctivitis can occur due to the stagnant collection of tears on the eye increasing the risk of bacterial contamination and conjunctivitis.
CNLDO can either be treated with conservative management or with a surgical procedure.
All cases are initially treated with conservative management, due to the large proportion of infants that experience spontaneous resolution and opening of the tear duct.
Conservative management involves massaging of the ducts, specifically the canaliculus which is situated on the outer upper part of the nose. Gentle pressure is applied to this area with downward strokes, in an effort to raise pressure and encourage opening of the duct. Any discharge from the eyes should be regularly cleaned. In the case of conjunctivitis, topical antibiotics are used.
Surgical intervention is recommended for infants over the age of 12 months with persistent symptoms. This will be required to be performed at a surgical operating facility and under a General Anaesthetic. A fine flexible probe is inserted into the tear duct to physically open the duct pushing through the membrane. This procedure has a 90% success rate.
In the event of persistent symptoms following this initial procedure, further surgery may be required and can involve stent insertion or balloon dacryoplasty.
Complications following nasolacrimal duct probing and stent insertion include nasal bleeding, restenosis of the duct and creation of a false passage of the duct, all of which are rare.
The prognosis for CNLDO resolution by one or more surgical procedures is excellent with a high success rate. Once the duct is patent, it is very rare to become stenosed or blocked again later in life.
The first consultation at Sydney Eye Surgeons will be a comprehensive paediatric ophthalmic assessment. This will require you to see our paediatric orthoptist who will perform the necessary tests for your child. Your child will require eye drops to be instilled in order for our Ophthalmologist to complete a comprehensive paediatric ophthalmic examination. These drops usually require 40 minutes for maximal effect. During this time you may leave the eye clinic rather than waiting in the waiting room, however, please check with our orthoptist prior to leaving.
Following this, our Ophthalmologist will examine your child and discuss the necessary issues and provide an appropriate treatment plan.
Please note, that your first consultation may take up to 2 hours to complete.
The drops that have been instilled may last for up to 24 hours. This is entirely normal.
The follow up consultations for your child will usually be of shorter duration. You will still see our paediatric orthoptist and your Ophthalmologist, however, drops are usually not required for every visit.
Eye drops may be required annually or if there are any issues detected that are unusual at any visit.