When Your Baby Needs Stent Surgery For a Clogged Tear Duct

My second daughter, Alice, had persistent issues with goo collecting in her right eye. Most days, it would then stick that eye closed after naps and bedtime. This post is our journey of treating her clogged tear duct, having surgery, and finally resolving the problem!

When Your Baby Needs Stent Surgery For a Clogged Tear Duct: What to expect, from a mom who has been through it all

What Is a Clogged Tear Duct?

For the first few weeks of a newborn’s life, she isn’t producing tears. This begins around two weeks after they are born and increases over the next few months. Once tears begin to flow, they come into the eye from a gland above the eye. Then the tears coat the eyes and drain through a tear duct at the inner eye.

Image of tear gland and duct anatomyImage Source

During Alice’s first few months, we could tell there was a problem with her right eye. Her eyes were often watery, and her right eyelid seemed to droop. Eyes watering is one of the first signs of a clogged tear duct. This is because her tears don’t drain properly, so they cause a watery or glassy look.

Her slight eyelid swelling or drooping was caused by irritation related to the clogged tear duct. Rubbing her eyes when they were crusted shut and excess moisture irritating the skin around her eyes exacerbated this problem.

Even while awake, we could see goop collecting in the inner corner of her eye until we cleared it out. My poor, sweet, girl hated this routine of getting her eye cleaned. Most of the time, the rubbing from cleaning would just irritate the skin around her eyes even more.

Baby with discharge in eye due to clogged tear duct

What Can You Do About It?

My husband and I weren’t alarmed early on because we had the same problem with our older daughter, Evelyn. Her eyes resolved with some chiropractic care when she was eight months old. As inconvenient as the problem was with Alice, we were hopeful that it would also clear up on its own.

Still, as Alice grew, she continued to wake from naps and bedtime with crusty eyes. We began to lovingly call it her “Pirate Eye”, and we had a routine of cleaning her eye while breastfeeding. Some days it was just a little bit of crust, and other days was a horrible buildup of gunk.

We also tried all of the common home remedies. Regular chiropractic adjustments, massaging gunk out of the tear duct multiple times each day, and squirting breastmilk in her eye. These are solutions, combined with time, that will typically open the duct by the time they turn one. Antibiotic eye drops aren’t typically prescribed for clogged tear ducts unless an infection is present, because antibiotics won’t treat the underlying cause.

Every time we took her to the doctor for a well-check, we would ask about her eye. He would then reassure us that this is normal for infants. But when she turned one and didn’t show any signs of her eye clearing up, we contacted the ophthalmology clinic at the local children’s hospital for a second opinion.

These videos demonstrate the clogged tear duct massage, Alice babbling with her eye crusted shut, as well as Alice before and after surgery.

Our Experience at the Ophthalmologist

We were able to get an appointment at the children’s hospital ophthalmology clinic within two weeks. Though we got in quickly, waiting was hard and we were anxious to find out what they would say. There was no special preparation for the appointment, aside from filling out paperwork.

I don’t have experience with any other clinics, but I would highly recommend starting at your local children’s hospital. Our hospital is completely secure and requires guests to have an ID to enter, and the staff is trained specifically to work with children. The waiting rooms are also far more tolerable because they are tailored to help entertain young children who are waiting.

During our appointment, they took the standard vitals (height, weight, length, heart rate, etc.) and did a standard vision examination. This included watching how her eyes reacted to light, putting in drops to dilate her eyes, and using special tools to test the prescription in each of her eyes. There is a slight concern with the prescriptions in her eyes, but that will be another blog post when we follow up next year. Then I had to hold her tightly in my lap while the doctor looked more closely at the structure of her eye and the tear duct of the affected eye.

The ophthalmologist recommended the tear duct probe and stent surgery on the spot and went to bring the surgeon in to confirm his recommendation. This was reassuring to me because of the personalized care we received, and because she saw multiple doctors in one visit to confirm that the surgery would be our best option.

So What Does This Surgery Entail?

Our surgeon told us that it would be a quick surgery, and only take about ten minutes. For short-term intubations, our team would use a special kind of intubation called a laryngeal mask. Then the surgeon uses a probe to pop open the path where the tears should be draining into the nasal passage. Finally, he inserts a silicone stent that will remain in place for a few months. This stent is a tiny tube that allows tears to drain and helps the new hole heal open, instead of closing back up. We could then expect a nearly 100% success rate in curing the clogged tear duct.

Before surgery, I watched the following video giving in-depth information about the type of stent Alice would be receiving. Although it is far more technical than I need to understand, I really appreciated the ability to understand exactly what her surgeon would be doing during the procedure.

This diagram of the Mini Monoka stent also helped me understand how the tube would stay in place without the use of stitches. Image Source

While any parent would be nervous about putting their child through general anesthesia, we were reassured daily that this is something she needs when we saw her poor eye. We informed ourselves about the surgery and understood that it would be quick, safe, and successful. Finally, our surgeon said that it didn’t look like her tear duct would open without surgical intervention, and we agreed with him.

Preparing Your Baby (and Yourself) for Surgery

The same-day-surgery clinic called us a few days before our scheduled date to tell us what time to arrive and how to prepare Alice for the procedure. They did not give us a surgery time when they originally put her on the calendar, because they wait to place each child on the surgery lineup until the week of surgery. The nurse also advised us of her fasting times – the final time she could have solid foods, breastmilk, and clear liquids. You need to inform the nurses if you are breastfeeding because different surgeons have different rules as to the final times they are allowed to breastfeed.

One of the guidelines for our same day surgery clinic is to give your child a bath the night before or the morning of surgery. This is a general precautionary task that helps prevent infections. While Alice’s procedure is mostly noninvasive, it is still important. She woke up from a late evening nap with her eye matted shut, giving us further confirmation that surgery was the right choice for our family.

The night before surgery, we loaded her up with a high protein dinner late in the evening to help hold her over. She could last have breastmilk at 3:30 in the morning, so I set an alarm and woke her at 3 am in order to nurse her at the end of that threshold. Finally, she could have clear fluids until 8 am. Our nurses said that jello, apple juice, Gatorade and water all count as clear liquids. So we gave her some jello and juice, both of which she rejected because these aren’t things that she typically eats.

That morning, we dropped Evelyn off at school and told her that Alice’s eye would be all better when we picked her up that afternoon! Finally, we stopped by Starbucks for some coffee to gear us up for the morning ahead.

Make sure that you get your drink ahead of time. No food or drink was allowed in our pre-op waiting room, out of respect for all of the fasting patients.

Baby with eye stuck shut due to clogged tear duct

Let’s Roll Into Pre-Op!

You never know how long you will wait in admissions and your pre-op room, so it is important to come prepared with distractions. We packed toys, videos on our phones, and my baby carrier.

There was no need to bring a stroller because our hospital has great little carts for carrying all of your things up to your clinic. They are also a perfect way to entertain your child with a ride around the hallways! I especially liked the cart because Alice kept signing “milk” when I carried her. Putting some distance between Alice and her milkies definitely helped her forget about it!

Baby waiting in pre-op for tear duct surgery

We invited our priest along to wait with us and say a prayer for Alice and her surgical team. This was a nice way to help me calm my nerves. Even though we were happy with the plan, it is still nerve-wracking to send your baby into general anesthesia. We had a late morning surgery time, so we spent a long time in our room waiting for Alice’s turn.

One of the hardest parts of waiting was that she demands closeness with me and I wasn’t able to breastfeed before surgery. To help with this, I brought along my Lillebaby baby carrier and wore a hoodie. For the most part, this made her happy and succeeded in blocking her access to nurse.

Baby waiting in pre-op for tear duct surgery

Wait, Is She Wearing a Cloth Diaper?!

Yep! We are a cloth diapering family, and my girls have never worn a disposable. Well… there was that one time, but my husband doesn’t like to talk about it, haha! I assumed that she would have to wear a disposable diaper during surgery, but it never hurts to ask!

When talking to the pre-op nurses, I asked if Alice would be able to wear her cloth diaper into surgery. This was absolutely not a deal-breaker for us, but I did want to understand everything we needed to expect that day. As long as there are no metal parts (our Blueberry Simplex are all fabric with plastic snaps), our hospital allows cloth diapers.

Plus, her nurses all commented on how cute she looked in her diaper! I’ve got to say, I agree! Her tiny hospital gown, hospital booties, and butterfly diaper were so sweet!

Baby waiting in pre-op for tear duct surgery

Child Life: Angels Who Specialize in Helping Children Cope in the Hospital

Child Life Specialists are incredible people who spend their careers helping children and their families cope while in the hospital. In the same day surgery clinic, their focus is on helping parents and children understand the procedure and making them comfortable while waiting.

Having an infant daughter, they weren’t explaining any of the procedures to Alice. But they had all kinds of distractions at the ready! This made our long wait much more tolerable. They had various buckets of toys appropriate for different ages and interests of children.

Alice was mostly annoyed by the toys, and would just throw them on the floor. But she was fully captivated by the bubbles! She was not at all impressed with Mama blowing bubbles while Daddy held her. Switching roles was what ended up entertaining her for over an hour – probably because Daddy blows the best bubbles!

Don’t forget to bring a lovey from home too! They will allow your child to bring a special toy or blanket along that will stay with them throughout surgery and recovery. Alice doesn’t have strong attachments to any of her stuffies or toys, so we chose to bring her soft and snuggly Build A Bear from her Nana.

Baby waiting in pre-op for tear duct surgery

The Hardest Part: Saying Goodbye, for Now

I am writing this post months after Alice’s tear duct surgery, and yet the following photo still makes me tear up. Even though we were fully informed, supportive of the decision, and trusting in her surgical team, watching her roll away without me was terrifying. Luckily, Alice was calm and went with the nurse happily. I can only imagine the pain it would have caused if she had been crying out for us.

Because she was sitting and playing calmly on the gurney, they wheeled her back that way. If she was in need of more comfort, a nurse would have carried her back in their arms.

Baby being wheeled away for surgery

Waiting and Waiting and Waking Up

A nurse then brought us to the same day surgery waiting room, where we sat for around an hour. Even though Alice had a fast surgery, it still took a fair amount of time to sedate her, set up her IV and airway, complete the surgery, and get her through the first recovery room.

I recommend that you bring along some snacks and drinks, as well as a phone charger for this time frame. I had brought money for the vending machines, but everything at the hospital was sugar-free. Yay for being healthy, but mama needs her Dr. Pepper!!!

Eventually, the receptionists called our name and directed us to a small room. Her surgeon met with us quickly to let us know that the surgery went well. Once Alice had come out of post-op anesthesia, a nurse came back to the waiting room to get us. She brought us down a short hallway where two other nurses and Alice were waiting. One was pushing Alice’s gurney which still had her IV fluids hanging, and the other was holding my groggy baby. I didn’t know when I could hold her and was ecstatic when she passed her to me right away.

Alice was fussing quietly, and the nurse said that she had refused her post-op sippy cup where they try to get your child to drink some water. I laughed and asked if it was okay for me to nurse Alice, to which the nurse said that was fine as soon as we were ready. So in the middle of the hospital hallway, I latched her on and immediately felt her tenseness melt away and she relaxed into my arms.

We spent the next thirty minutes in a curtained recovery area. Alice nursed while getting her IV removed and while Eric dressed her in her own clothes. She was awake and attentive, but her body still felt heavy because she was still bogged down by the sedation.

Baby with mom recovering after surgery

The biggest post-op surprise for me was when she peed through her diaper and my pants, haha! She never wets enough to soak a diaper, much less to leak through. But all of the extra fluid in her little body from the IV had to come out one way or another!

Alice slept away the rest of the afternoon and was fussier than usual. Later that afternoon, we picked Evelyn up from school and brought her to gymnastics. She was groggy and irritated by just about everything, and just wanted to snuggle at home. Luckily, she was 100% back to normal by the next day.

So…What Does It Look Like?

Where the bottom tear duct opening is on her inner eyelid, was a tiny silicone rectangle with a hole in it. The hole allowed for her tears to drain properly while the hole created by the probe heals.

Our surgeon reassured us that it is unusual, but not unheard of for a child to pull out their stent on accident. That they might pop it loose and pull it out while rubbing their eyes. He said we might find something that looks like a clear piece of spaghetti in her crib, or we might never find it. This made my husband and I both really nervous because we didn’t want to go through the surgery just to have her pull it out! Luckily, that wasn’t ever a problem for us.

In fact, we had zero problems over the next few months! After the surgery, she did not have a single day of the crusty eye all summer long! The clogged tear duct was history and just a bad memory. It was truly everything that we had hoped for. The irritated skin and inflammation cleared up, and she wasn’t even aware that the stent was in there.

Image of stent in place before removal

Stent Removal Appointment

Around three and a half months after the surgery, we had a follow-up appointment. The same surgeon who did the tear duct procedure met with us to do another vision exam and remove the stent. Stent removal was so quick and easy! I held Alice in my lap with one arm holding her head still and one arm restraining her arms gently.

The surgeon used a sterile tweezer-like tool to grab the plug of the stent, and then it was out with just a tiny tug. Alice didn’t love this, but she only cried for a moment. She did rub her eye a lot over the next thirty minutes, but she wasn’t in any pain. He recommended that we come back for a follow up next spring because she still may need glasses (yay 🙄). Then it was over! No more clogged tear duct, no more stent!

Big sister came along to this appointment, and was so helpful pushing Alice around in the cart! My favorite part of this appointment was Alice mistaking the dramatic ceiling lights for the Amazon Echo Dots! She kept shouting “sah! sah! sah!” which is her word for “Alexa”.

Baby at doctor's office for stent removal

Post Stent Removal

We awoke to our worst-case scenario just a few days after having the stent removed. The Pirate Eye had returned for the first time in 3.5 months. I panicked and sent the ophthalmologist clinic an email with photos and asked if we need to be seen for another follow-up. I was imagining the worst case scenario of her tear duct somehow closing back up.

During the day, we notice small amounts of gunk accumulating in the corner of her eye. This is so frustrating, and I was ready to fight for another surgery before the end of the year.

Fortunately, our surgeon called personally and reassured us that this shouldn’t be a big problem. He said that it can take some time for the tear duct to be able to handle all of her tears without the stent. Then he reassured us that he has never had this surgery fail.

She still gets a yucky eye from time to time, but it’s not as concerning as before the surgery. We are still watchful, as it would be just like Alice to be the first one to have the surgery fail. But we are hopeful that this is a temporary hurdle in our path.

Baby with eye stuck shut due to clogged tear duct

Where Are You at in Your Journey?

This has been a challenging process, but it has been totally worthwhile! Are you reading because your child has or had a clogged tear duct? I would love to hear what has been similar or different for you and your child. Leave a comment below, and I would be happy to answer any questions about our experience.

baby sitting and smiling

Gallery of Additional Photos

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