Congenital Nasolacrimal Duct Obstruction

Congenital Nasolacrimal Duct Obstruction
SYMPTOMS Epiphora, Mucus discharge
SIGNS Typically unilateral
Epiphora and Mucus discharge especially around the puncta, Inferior medial canthal swelling
WORK-UP Pupils, EOMs, Full eye exam, Fluorescein dye disappearance test, Palpation of the lacrimal sac
TREATMENT No treatment is usually needed as the nasolacrimal duct obstruction typically resolves within the first year of life
The Crigler massage or Hydrostatic massage will help with resolution especially if done 2-4 times a day
Ophthalmic antibiotic drops or ointment should only be used if there is an ocular infection and/or mucus discharge present
Refer to an Oculoplastic specialist or Pediatric ophthalmologist for high pressure irrigation, probing, and other more invasive procedures if nasolacrimal duct obstruction is not resolving (should wait until patient is 15-18 months of age)
FOLLOW-UP Should see patient back in 4-6 months if observing for resolution of the nasolacrimal duct obstruction
Should see patient back in 1-2 weeks if treating patient with ophthalmic antibiotics
Once the congenital nasolacrimal duct obstruction is treated by an oculoplastic specialist/pediatric ophthalmologist and the eye is stable, the patient should be seen back in 6-12 months
ETIOLOGY Mechanical obstruction located distally to the nasolacrimal duct at the valve of Hasner
DIFFERENTIAL DX Conjunctivitis, Dacryocystitis, Dacryocytocele
NOTES Highly associated with anisometropic amblyopia