Case Presentation:Clogged Tear Duct

Tonya A. Westerbeke, D.C.Back To Health Chiropractic Wellness Center

10990 Chicago DriveZeeland, MI 49464

616.546.3500

Medical DefinitionMedical Definition

• Prevents your tear duct from draining Prevents your tear duct from draining naturallynaturally

• Caused by a partial or complete Caused by a partial or complete obstruction in the drainage systemobstruction in the drainage system

• Up to 20% of newborns have at birth, Up to 20% of newborns have at birth, usually clears within the first year of usually clears within the first year of lifelife

• Almost always correctable, depends Almost always correctable, depends on cause and ageon cause and age

SymptomsSymptoms

• May be caused by the blocked tear May be caused by the blocked tear duct or from infection that developsduct or from infection that develops

• Excessive tearing, watery eyes, Excessive tearing, watery eyes, recurrent eye inflammation recurrent eye inflammation (conjunctivits), recurrent eye (conjunctivits), recurrent eye infections, painful swelling insode infections, painful swelling insode corner of eye, eye mucus discharge, corner of eye, eye mucus discharge, blurred vision, bloody tearsblurred vision, bloody tears

How it worksHow it works

• Tears come from lacrimal glands, Tears come from lacrimal glands, located above each eyelocated above each eye

• Flow down the surface of eye to Flow down the surface of eye to lubricate and protect, then drain in lubricate and protect, then drain in tiny holes in corner of lidstiny holes in corner of lids

• Travel through these canals, and Travel through these canals, and evaporate or reabsorbedevaporate or reabsorbed

How it works cont.How it works cont.

• Blockage can occur at any point in Blockage can occur at any point in the drainage system, from puncta to the drainage system, from puncta to nose.nose.

• This occurs, tears don’t drain properly This occurs, tears don’t drain properly giving watery eyes and increasing giving watery eyes and increasing risk of eye infections and risk of eye infections and inflammation.inflammation.

CausesCauses

• Congenital Blockage up to 20% Congenital Blockage up to 20% newbornsnewborns

− Drainage system may not be fully Drainage system may not be fully developed or duct abnormalitydeveloped or duct abnormality

− Thin membrane often remains over the Thin membrane often remains over the opening that empties into the nose opening that empties into the nose (lacrimal duct) in congenitally blocked tear (lacrimal duct) in congenitally blocked tear ducts.ducts.

− Usually opens spontaneously 1Usually opens spontaneously 1stst or 2 or 2ndnd months of lifemonths of life

Causes contCauses cont

• Abnormal Development of skull or Abnormal Development of skull or faceface

− Down’s syndrome, increased liklihood of Down’s syndrome, increased liklihood of blockage of the tear ducts.blockage of the tear ducts.

− My opinion, but left out in literature search is My opinion, but left out in literature search is plagiocephalyplagiocephaly

• Chronic eye infectionsChronic eye infections− Can cause tear ducts to be blockedCan cause tear ducts to be blocked

Causes cont.Causes cont.

• Facial Injuries or trauma sustained by Facial Injuries or trauma sustained by traumatic birthing process could traumatic birthing process could cause bone damage near the cause bone damage near the drainage system and disrupt the drainage system and disrupt the normal flow of tears through the normal flow of tears through the ductsducts

• Tumors along the nasal, sinus, or Tumors along the nasal, sinus, or lacrimal sac tumors. Or cysts or lacrimal sac tumors. Or cysts or stonesstones

ComplicationsComplications

• When not draining tears remain in When not draining tears remain in the drainage system, become the drainage system, become stagnant, promoting the growth of stagnant, promoting the growth of bacteria, viruses, and fungi.bacteria, viruses, and fungi.

• Organisms lead to recurrent eye Organisms lead to recurrent eye infections and inflammationinfections and inflammation

Tests and DiagnosisTests and Diagnosis

• Tear drainage test (flouorescein dye Tear drainage test (flouorescein dye disappearance test): test drainage, disappearance test): test drainage, one drop special dye in each eye. If one drop special dye in each eye. If significant amount of dye in eye after significant amount of dye in eye after 5 min of normal blinking, may have 5 min of normal blinking, may have blocked ductblocked duct

• Irrigation or probing: fluch saline Irrigation or probing: fluch saline solution or slender probe insertedsolution or slender probe inserted

Allopathic TreatmentAllopathic Treatment

• Cause determines treatmentCause determines treatment− Infection= AntibioticsInfection= Antibiotics− Tumor= surgery or recommendations on Tumor= surgery or recommendations on

shrinkingshrinking− Non-tumor blockage from observation to Non-tumor blockage from observation to

surgerysurgery− Most pts I have encountered, told not to Most pts I have encountered, told not to

worry until after 1 year then addressworry until after 1 year then address

Allopathic treatment cont.Allopathic treatment cont.

• After the first couple of monthsAfter the first couple of months− Specific massage recommendedSpecific massage recommended− Dilation, probing, and irrigation to open Dilation, probing, and irrigation to open

congenital blocked tear ductscongenital blocked tear ducts− Can be done using general anesthesia or Can be done using general anesthesia or

restrains in young babiesrestrains in young babies− Punctal openings are enlarged with dilation Punctal openings are enlarged with dilation

instrument and probe inserted, pierces thin instrument and probe inserted, pierces thin membrane, popping noise can be heard, membrane, popping noise can be heard, probe removed, flushed with saline solutionprobe removed, flushed with saline solution

− Balloon catheter dilation, stenting, or Balloon catheter dilation, stenting, or intubationintubation

Chiropractic treatmentChiropractic treatment

• At this time, no papers were found At this time, no papers were found describing how to assist a patientdescribing how to assist a patient

Case Presentation/HistoryCase Presentation/History

• 2 week old female presents with 2 week old female presents with inability to burp, (just like her inability to burp, (just like her brother), infrequent bowel brother), infrequent bowel movementsmovements

• Mother under care during Mother under care during pregnancy, had issue with rib painpregnancy, had issue with rib pain

• Planned C-section, was stuck up Planned C-section, was stuck up under ribs and tried pulling, vacuum under ribs and tried pulling, vacuum usedused

Case Presentation cont.Case Presentation cont.

• Breast fed, prefers right side, feeding Breast fed, prefers right side, feeding every 30 minutes last night, 2-3 hours every 30 minutes last night, 2-3 hours dayday

• Apgar scored normal 1 & 5 minutesApgar scored normal 1 & 5 minutes• Md told to use Caro syrup for bowel Md told to use Caro syrup for bowel

issues, makes baby more issues, makes baby more uncomfortableuncomfortable

• Prefers sleep backPrefers sleep back

Case presentation contCase presentation cont

• After clear up of the initial After clear up of the initial complaints in 2 visits, the patient complaints in 2 visits, the patient continued on wellness care.continued on wellness care.

• At 3 months presented for wellness At 3 months presented for wellness care and noticed copius amounts of care and noticed copius amounts of mucus in inner eye. Mom admitted mucus in inner eye. Mom admitted she cleans religiously but forgot she cleans religiously but forgot running behind. MD told to not worry running behind. MD told to not worry till after 1 yeartill after 1 year

Exam FindingsExam Findings

• Left parietal overlappingLeft parietal overlapping• Cone/elongated headCone/elongated head• Very strong sucking reflex!Very strong sucking reflex!• Parietal and Temporal mis-shapedParietal and Temporal mis-shaped• Muscle spasm noted C1, T1-4, T11&12Muscle spasm noted C1, T1-4, T11&12• Later apt, occipital flatteningLater apt, occipital flattening

Treatment Treatment

• Modified Diversified technique: Modified Diversified technique: gentle pressure with 3gentle pressure with 3rdrd finger with finger with slight lateral flexion of cspine, slight lateral flexion of cspine, thoracic gentle P-A pressure while thoracic gentle P-A pressure while patient was supine in armspatient was supine in arms

• Cranial sacral protocol as taught by Cranial sacral protocol as taught by Dr. Carol Phillips specific attention to Dr. Carol Phillips specific attention to shenoid, ethmoid and occiputshenoid, ethmoid and occiput

• No adverse reactions notedNo adverse reactions noted

Recommendations for careRecommendations for care

• Chiropractic treatment Chiropractic treatment recommended 1 time a week for 4 recommended 1 time a week for 4 weeksweeks

• Home recommendationsHome recommendations− Lacrimal massageLacrimal massage− Mimic cranial techniques: sphenoid, Mimic cranial techniques: sphenoid,

ethmoid and occiputethmoid and occiput− Mom felt it was the occiput technique that Mom felt it was the occiput technique that

was the magic cure saw significan changes was the magic cure saw significan changes when we addedwhen we added

Recommendations for careRecommendations for care

• Supplements: Supplements: − For bowel issues earlier: probioticsFor bowel issues earlier: probiotics− Clogged tear duct: Colloidal silver and Clogged tear duct: Colloidal silver and

follow directions on the bottlefollow directions on the bottle• Colloidal silver is nature’s own antibiotic, Colloidal silver is nature’s own antibiotic,

kills bacteria, viruses and funguskills bacteria, viruses and fungus• Argyria is a condition caused by the Argyria is a condition caused by the

ingestion of elemental silver, silver dust ingestion of elemental silver, silver dust or silver compounds which is often linked or silver compounds which is often linked to colloidal silverto colloidal silver

OutcomeOutcome

• Condition resloved 100% within 3 Condition resloved 100% within 3 chiropractic treatment, mom chiropractic treatment, mom completing the homework and the completing the homework and the supplements recommendationssupplements recommendations

LimitationsLimitations

• Of 3 patients that presented with this Of 3 patients that presented with this condition, 2 over the age of one and condition, 2 over the age of one and the parents were not compliant with the parents were not compliant with care and homework and saw no care and homework and saw no resolution of issue. The one child resolution of issue. The one child under 1, and mom completely under 1, and mom completely compliant, resolution of condition.compliant, resolution of condition.

Thank you!