Congenital Nasolacrimal Duct Obstruction

Congenital nasolacrimal duct obstruction (CLDO) is literally a tear duct that has failed to open at the time of birth. Around 6% of infants have CLDO, usually experiencing a persistent watery eye even when not crying. If a secondary infection occurs, purulent (yellow / green) discharge may be present.

Most cases resolve spontaneously, with antibiotics reserved only if conjunctivitis occurs. Lacrimal sac massage has been proposed as helping to open the duct, though this is not always successful. The aim of massage is to generate enough hydrostatic pressure (downward, toward the nose) to “pop” open any obstruction. Additional massage may then be performed up toward the lacrimal punctum, in order to express any infectious material out of the nasolacrimal sac. When discharge or crusting is present, the lids should be gently cleaned using cooled pre-boiled water or saline.

Referral to Dr. Vick is indicated if symptoms are still present at 12 months, or sooner if significant symptoms or recurrent infections occur. Nasolacrimal duct probing may be performed in the office setting (usually from 4 to 8 months of age) or under general anesthesia in an operating room for older patients. The success rate of probing is higher for younger children. A silastic tube or stent may be employed along with probing to maintain tear duct patency.

 

References: Young JD, MacEwen CJ., Managing congenital lacrimal obstruction in general practice. BMJ. 1997 Aug 2 Engel JM, Hilchie-Schmidt C, Khammar A, Ostfeld BM, Vyas A, Ticho BH: Monocanalicular silastic intubation for the initial correction of congenital nasolacrimal duct obstruction.