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Nasolacrimal duct obstruction

  • Nasolacrimal duct obstruction (i.e. blockage of the lacrimal duct) is very common - occurs in 5% of in infants

  • The most distal part of the nasolacrimal duct is usually the last part to become patent and normally this occurs soon after birth

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Presentation

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  • Epiphora (excessive eye-watering)

    • Matting of eye lashes

  • Purulent discharge

    • ​important to differentiate from conjunctivitis

        • sometimes superimposed conjunctivitis can occur 

      • If eye red and sticky = likely conjunctivitis, if sticky but not red = likely duct obstruction

  • Visual acuity is normal 

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Management

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  • Most (>85%) spontaneously resolve within first 12 months of life

  • Topical antibiotics

  • Nasolacrimal sac massage

  • If doesn’t settle after 1 year, intervention required: lacrimal probing​

    • Fine wire passed into nasolacrimal duct to break through the obstruction (obstructing membrane)

    • Performed under GA; whole procedure lasts a few minutes

    • Most cases (>90%) successful following first procedure

      • If first procedure fails, success rate still good for second procedure; alternative measures include inserting silicone tubing & balloon dilatation

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References

  • Salmon, J. F. (2019) Kanski’s clinical ophthalmology. 9th edn. London, England: Elsevier Health Sciences.

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