What is the treatment for a baby with chemosis and blocked tear ducts?

Treatment for Chemosis and Blocked Tear Ducts in Babies

For babies with chemosis and blocked tear ducts, conservative management with massage of the lacrimal sac and topical antibiotics is the recommended first-line treatment until 12 months of age, after which probing may be considered if symptoms persist.

Understanding the Condition

Chemosis (conjunctival swelling) in babies can occur alongside nasolacrimal duct obstruction (NLDO), which is a common condition affecting 5-20% of infants. The main symptoms include:

• Excessive tearing (epiphora)
• Mucoid discharge from the eyes
• Conjunctival swelling (chemosis)
• Possible skin maceration around the eyelids
• Recurrent conjunctivitis

First-Line Treatment Approach

Conservative Management (0-12 months)

1. Lacrimal sac massage:

   • Teach parents to perform gentle digital pressure over the lacrimal sac
   • Apply pressure in an upward direction to express contents
   • Perform 2-4 times daily

2. Eye care:

   • Regular cleaning of eyelids with sterile saline or warm water
   • Remove debris from around the eyes

3. Topical antibiotics (if signs of infection):

   • Use only when conjunctivitis is present
   • Apply as directed by healthcare provider

Monitoring and Follow-up

• Regular assessment of symptoms
• Monitor for signs of worsening infection
• Follow up every 2-3 months to assess resolution

When to Consider Probing

The evidence from research studies supports a conservative approach initially, as many cases resolve spontaneously:

• One study showed a 93.3% cure rate with conservative management in children 1-12 months of age 1
• Another study demonstrated that 77 of 117 (66%) eyes resolved without surgery after 6 months of observation 2

Consider probing if:

• Symptoms persist beyond 12 months of age
• Recurrent severe infections occur
• Significant impact on quality of life

Probing Procedure Considerations

If probing becomes necessary:

• Can be performed in office setting or under general anesthesia
• Success rates are higher when performed after failed conservative management
• Potential complications include false passage creation, injury to nasolacrimal structures, and bleeding 2

Special Considerations for Severe Chemosis

For severe, refractory chemosis that doesn't respond to standard treatments:

• Topical steroids may be considered for short-term use on inflamed areas 3
• In extreme cases where other conservative therapies fail, topical adrenaline (1:1000) has been reported effective in one case study, though this should only be considered under specialist guidance 4

Important Caveats

1. Avoid unnecessary early intervention: Most cases resolve spontaneously with conservative management by 12 months of age.

2. Watch for complications: Monitor for signs of skin maceration or recurrent infections that may require more aggressive treatment.

3. Parental education: Proper instruction on massage technique and eye hygiene is crucial for successful conservative management.

4. Cost considerations: Conservative management is more cost-effective than immediate probing (mean difference of approximately USD -139) 2.

By following this approach, approximately 86.4% of children can be spared nasolacrimal probing procedures 1, reducing unnecessary interventions while effectively managing symptoms.