Congenital Nasolacrimal Duct Obstruction

Congenital Nasolacrimal Duct Obstruction
		SYMPTOMS	Epiphora, Mucus discharge
		SIGNS	Typically unilateral
		SIGNS	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
ADDITIONAL LAB \| TESTS	None
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