Congenital lacrimal duct obstruction
Encyclopedia
Congenital nasolacrimal duct obstruction (CLDO) is the condition in which a tear duct 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. The condition is also known as dacryostenosis. If a secondary infection occurs (Dacryocystitis
), purulent (yellow / green) discharge may be present.
s 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 an ophthalmologist 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.
Dacryocystitis
Dacryocystitis is an infection of the nasolacrimal sac, frequently caused by nasolacrimal duct obstruction. The term derives from the Greek dákryon , cyst , and -itis . It causes pain, redness, and swelling over the inner aspect of the lower eyelid and epiphora...
), purulent (yellow / green) discharge may be present.
Prognosis and treatment
Most cases resolve spontaneously, with antibioticAntibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s reserved only if conjunctivitis
Conjunctivitis
Conjunctivitis refers to inflammation of the conjunctiva...
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
Lacrimal punctum
The lacrimal canaliculi, one in each eyelid, commence at minute orifices, termed puncta lacrimalia , on the summits of the papillae lacrimales, seen on the margins of the lids at the lateral extremity of the lacus lacrimalis...
, 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 an ophthalmologist 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
Silastic
Silastic is a trademark registered in 1948 by Dow Corning Corporation for flexible, inert silicone elastomer...
tube or stent
Stent
In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
may be employed along with probing to maintain tear duct patency.