Question:
My 6-year old son has recently undergone exploratory surgery to investigate recurring eye infections with itching and discharge. We have discovered that he was born without a tear duct in his left eye. Can you offer any advice as to what the next step could be in terms of treatment?
Answer:
I am assuming that when you say that your son was born without a tear duct you mean that the lacrimal drainage system appears abnormal.
This is the portion of the tear system responsible for draining tears from the eye.
There are a number of problems that can occur in the development of the drainage system, although absence of the system is very unusual.
Most commonly, some portion of the system (but not the entire system) is absent, narrow, or obstructed.
In all such cases, management depends upon the nature of the child’s particular abnormality.
Some solutions are straightforward, such as probing procedures to open a narrowed or obstructed drainage system.
Other solutions require more extensive surgery designed to create an alternative drainage pathway for tear passage.
It is therefore important to obtain an accurate diagnosis because this will ultimately lead to recommendation on a specific solution(s) for your child.
You should consider having your child seen by either a pediatric Eye M.D. or an Eye M.D. who specializes in plastic surgery.
Answered by:
David K. Coats, MD 
