Overview of Crigler Technique for Congenital Nasolacrimal Duct Obstruction

Congenital nasolacrimal duct obstruction (CNLDO) is a condition that prevents the drainage of tears in newborns. This usually leads to a symptom known as “epiphora”, which means a constant overflow of tears onto the face. This issue can happen to anywhere between 5% and 20% of babies. A large study in the UK showed that about 20% of infants within their first year had epiphora and 95% of those babies started showing symptoms at one month old. It’s more common in premature babies, with about 14% to 34% of CNLDO cases affecting both eyes.

This problem might raise the risk of a vision condition called anisometropic amblyopia, which results in one eye focusing better than the other. Therefore, all babies with this condition have their eyes checked carefully, followed by regular check-ups for three to four years.

Studies have shown that 13 out of 15 stillborn babies had a blocked tear duct, indicating that the tear duct opens up a few days or weeks after birth. So, most babies show signs of excessive tearing and sometimes even discharge from their eyes within a few months of being born. However, some babies may not show symptoms until they are several years old. Other causes of excessive tearing, like a rare eye disorder known as epiblepharon, inherited eye condition called congenital glaucoma, a foreign object in the eye, or infections need to be ruled out.

A test called the Jones 1 test, can be performed where a dye is inserted into the eye and if the duct is clear, the dye will appear in the nose after 5 minutes. However, this test is now rarely used as the symptoms of constantly tearing and discharge usually confirm the condition. Similarly, a test that looks for dye disappearance over 5 minutes can be used, but can sometimes produce wrong results in babies.

Anatomy and Physiology of Crigler Technique for Congenital Nasolacrimal Duct Obstruction

The tear drainage system, medically known as the excretory lacrimal system, consists of several parts including small openings known as puncta, tiny channels called canaliculi, a tear sac named the lacrimal sac, and a tear duct known as the nasolacrimal duct. This tear duct opens up inside the nose. In some babies, this system may be blocked, preventing tears from draining properly, and this is known as Congenital Nasolacrimal Duct Obstruction (CNLDO).

There are a few potential causes for this blockage. Sometimes, the issue may be due to the persistence of a thin tissue at the end of the tear duct, or due to abnormalities in the bone structure nearby. It has also been noticed that some parts of the drainage system becoming narrower could cause a blockage. This blockage can present differently, some babies may have a slimy discharge while others may have a watery one.

Interestingly, many infants tend to outgrow this condition within the first year of life. In fact, it has been observed to resolve on its own in up to 95% of infants by the time they turn 13 months old. A study showed that the rate of self-resolution is the highest within the first three months of life, and it gradually decreases with age.

Various research studies have confirmed this. One looked at 113 children with CNLDO and found that gentle massage and use of eye ointment helped cure 93% of them by 8 months of age without any additional intervention. Another study in Japan showed similar results, with conservative treatment working for 82.9% of the affected tear ducts by the age of 12 months.

An investigative group studied different treatment methods and found that 66% babies’ issue resolved without intervention within six months. There’s hope for older kids as well, because studies showed that even those still experiencing symptoms after 12 months spontaneously recover in about 44% of cases between the first and second years of life. In cases where both eyes are affected, the second eye tends to resolve within three months after the first one.

Doctors usually manage CNLDO conservatively for the first 12 months unless there is severe swelling or infection. This management involves either observing the child or using a gentle massage technique on the tear sac. While the benefit of massage has been debated, several studies have shown positive results with the technique. In fact, when compared to simple observation, massaging has been found to lead to a better resolution rate.

Antibiotics for CNLDO should only be given if there’s an active infection. Prophylactic (preventive) use of antibiotics hasn’t shown to improve outcomes. If conservative management doesn’t work, other options may be considered. One is high-pressure irrigation, which involves pushing a saline solution through the drainage system to open up the blockage. This has been effective in children, but it’s hardly used now. Another option is nasolacrimal duct probing, a surgical procedure typically done under general anesthesia, which has been found to be successful in most children, although the success rate decreases as the child gets older.

Why do People Need Crigler Technique for Congenital Nasolacrimal Duct Obstruction

The massage method that we’re talking about is recommended:

* For all newborn babies who have excessive tearing due to a blocked tear duct at birth
* This treatment should start as soon as a child with a blocked tear duct is identified, no matter what their age is.
* The treatment should still be used even if a child is waiting to have a more intense treatment, like a small surgical procedure, a method to put a tube in the tear duct, or a process to enlarge the tear duct with a balloon.
* If the child has a thick and sticky discharge and is waiting for a surgery to create a new tear duct passage, this massage technique can help reduce the amount of this discharge that appears in the eye during the day.

When a Person Should Avoid Crigler Technique for Congenital Nasolacrimal Duct Obstruction

There are times when it is not safe to use a certain massage technique, such as:

– If a child has a sudden case of dacryocystitis, which is a type of eye infection.
– If a child’s tears are caused by canalicular scarring or punctal agenesis. Canalicular scarring is when there is a scar in the tear duct, making it hard for tears to drain. Punctal agenesis refers to the situation where the opening to the tear duct isn’t properly formed.

Equipment used for Crigler Technique for Congenital Nasolacrimal Duct Obstruction

You don’t need any special tools or equipment to perform this method, as the video demonstrates.

Who is needed to perform Crigler Technique for Congenital Nasolacrimal Duct Obstruction?

One of the parents needs to use this method on the tear sac and tear duct. The tear sac and tear duct are parts of your eye that help drain tears away. It’s important to use the technique correctly to make sure it works properly.

Preparing for Crigler Technique for Congenital Nasolacrimal Duct Obstruction

The best time to carry out this procedure is after the child has been fed and is asleep, comfortably resting in the arms of their parent.

How is Crigler Technique for Congenital Nasolacrimal Duct Obstruction performed

There’s a special technique that doctors use when treating certain eye conditions in infants. This method was first introduced in 1923 by Mr. Crigler at the New York Academy of Medicine. Here’s how it works:

The baby’s head is gently held between the doctor’s knees, similar to how one might inspect an eye. If the right eye is affected, the doctor will place their thumb over the area of the tear duct, closing off any backflow of tears. The thumb is gently pressed down over the tear duct, applying pressure against the edge of the eye socket. While keeping this pressure, the thumb is then moved towards the right, also pressing downwards sharply over the tear duct. This pressure moves any fluid inside the tear duct to the walls, which then open up at their weakest point – the nose opening. To ensure this method works properly, the doctor must ensure the pressure is only applied when the tear duct is full, that the thumb is correctly positioned to prevent any backflow of tears into the eye, and that a sudden pressure move is made over the tear duct. This builds enough pressure to break through the protective layer separating the nose from the tear duct.

Kushner shares a similar technique, called the hydrostatic massage. Here, the doctor places their finger on the common tear duct to block its exit, then firmly strokes downwards to apply pressure within the tear duct. The parents are asked to do this massage four to five times a day until the child is six months old.

We’ve tweaked this method a little bit, too. Even if only one eye is tearing, we massage both sides. This is done by applying pressure with the thumb on one side and the forefinger on the other side of the nose, over the tear ducts. This is easiest when the child is well-fed and sitting in a parent’s lap. We ask the parents to do this massage, with five to ten “strokes”, four times a day. We start the treatment at the first appointment and regularly check up on the child every three to four months.

Possible Complications of Crigler Technique for Congenital Nasolacrimal Duct Obstruction

If you’re applying too much force or ointment to the inner corner of your eye (the medial canthal region), the skin could get very wet and break down, which is called maceration. If this happens, you would need to apply the ointment less often. You might also need to use a skin moisturizer to help the area heal.

What Else Should I Know About Crigler Technique for Congenital Nasolacrimal Duct Obstruction?

This technique is highly effective in resolving the issue of CNLDO (Congenital Nasolacrimal Duct Obstruction; a common condition in infants in which the normal flow of tears is blocked) in children without needing surgery. It does not need any special equipment or medicines, so it’s recommended for all children who have CNLDO.

Frequently asked questions

1. How does the Crigler Technique work to treat Congenital Nasolacrimal Duct Obstruction? 2. Are there any risks or potential complications associated with the Crigler Technique? 3. How often and for how long should I perform the massage technique at home? 4. What signs or symptoms should I look out for that may indicate the need for additional treatment or intervention? 5. Are there any specific instructions or precautions I should follow while performing the Crigler Technique at home?

The Crigler Technique for Congenital Nasolacrimal Duct Obstruction (CNLDO) is not mentioned in the provided source of truth. Therefore, it is not possible to determine how the Crigler Technique will affect an individual with CNLDO based on the given information.

You may need the Crigler technique for congenital nasolacrimal duct obstruction if other treatment options, such as massage, are not safe or effective. This technique is typically used in cases where a child has a sudden case of dacryocystitis (eye infection) or if their tears are caused by canalicular scarring or punctal agenesis.

You should not get the Crigler Technique for Congenital Nasolacrimal Duct Obstruction if you have a sudden case of dacryocystitis or if your tears are caused by canalicular scarring or punctal agenesis.

The recovery time for the Crigler Technique for Congenital Nasolacrimal Duct Obstruction is not specified in the given text.

To prepare for the Crigler Technique for Congenital Nasolacrimal Duct Obstruction, the patient should ensure that the baby is well-fed and comfortably resting in the arms of a parent. The technique involves gently holding the baby's head between the doctor's knees and applying pressure with the thumb over the tear duct, moving it towards the affected side. The technique should be performed by the parents four times a day, with five to ten "strokes" each time, and regular check-ups should be scheduled every three to four months.

The complications of Crigler Technique for Congenital Nasolacrimal Duct Obstruction include maceration of the skin in the inner corner of the eye, which can occur if too much force or ointment is applied to that area. This can lead to skin breakdown and may require less frequent application of the ointment and the use of a skin moisturizer to aid in healing.

Excessive tearing, blocked tear duct at birth, thick and sticky discharge.

There is no mention of the safety of the Crigler Technique for Congenital Nasolacrimal Duct Obstruction in pregnancy in the provided text. Therefore, it is unclear whether this technique is safe to use during pregnancy. It is recommended to consult with a healthcare professional for specific advice regarding this matter.

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