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SYMPTOMS
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Epiphora, Mucus discharge
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Epiphora and Mucus discharge especially around the puncta, Inferior medial canthal swelling
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WORK-UP
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Pupils, EOMs, Full eye exam, Fluorescein dye disappearance test, Palpation of the lacrimal sac
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TREATMENT
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No treatment is usually needed as the nasolacrimal duct obstruction typically resolves within the first year of life
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The Crigler massage or Hydrostatic massage will help with resolution especially if done 2-4 times a day
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Ophthalmic antibiotic drops or ointment should only be used if there is an ocular infection and/or mucus discharge present
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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)
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FOLLOW-UP
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Should see patient back in 4-6 months if observing for resolution of the nasolacrimal duct obstruction
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Should see patient back in 1-2 weeks if treating patient with ophthalmic antibiotics
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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
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ETIOLOGY
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Mechanical obstruction located distally to the nasolacrimal duct at the valve of Hasner
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DIFFERENTIAL DX
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Conjunctivitis, Dacryocystitis, Dacryocytocele
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NOTES
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Highly associated with anisometropic amblyopia
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