1. Background

• persistence of a membrane at the lower end of the nasolacrimal duct results in an incomplete canalization of the nasolacrimal duct leading to an obstruction of the duct
• also called Congenital Nasolacrimal Duct Obstruction

1. Ophthalmologic Manifestations

• tearing within the affected eye
  • wetness of the eye
  • pooling or puddling of tears
  • epiphora - frank overflow of tears
• accumulation of mucoid or mucopurulent discharge in the affected eye resulting in crusting (usually upon awakening)
• erythema or maceration of the skin under the eye
• expression of clear fluid or mucopurulent discharge by massaging the area of the nasolacrimal sac
• may be intermittent or continuous over several months
• an upper respiratory tract infection may exacerbate this condition
• usually unilateral but can be bilateral
• conjunctival erythema and irritation is minimal

2. Complications

1. Conservative

• nasolacrimal massage 2-3 times per day followed by cleansing of the eyelid with warm water
• topical antibiotics for mucopurulent drainage
• 90% of cases resolve after 1 year of age with conservative management

2. Lacrimal Probing

• indicated if the condition does not respond to conservative management by 1 year of age
• may be repeated 1 or 2 times before surgery

3. Surgery

• definitive surgery is indicated when probing fails to resolve the problem or there are complications (dacryocystitis, pericystitis, periorbital cellulitis)
• silicone tube insertion
• dacryocystorhinostomy

4. Complications

• need to be treated with antibiotics

1. Rudolph A.M.; Rudolph's Pediatrics. 19th Edition; p. 1901; 1991.