Congenital lacrimal duct obstruction
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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 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 .
References
- ^ Young JD, MacEwen CJ., Managing congenital lacrimal obstruction in general practice. BMJ. 1997 Aug 2;315(7103):293-6. Article PMID 9274552
- ^ 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. JAAPOS. 2007 Apr;11:183-6. [5] PMID 17307001
See also
Congenital malformations and deformations of eye, ear, face and neck (Q10-Q18, 743-744) | |
|---|---|
| Eyes | eyelid, lacrimal apparatus and orbit: Ptosis - Ectropion - Entropion - Distichia - Blepharophimosis - Congenital lacrimal duct obstruction
entire eye: Anophthalmia - Microphthalmia lens: Ectopia lentis - Aphakia Aniridia - Axenfeld syndrome - Buphthalmos - Coloboma - Hydrophthalmos - Keratoglobus - Zazam Sheriff Phillips syndrome |
| Ears | Microtia |
| Other face and neck | Otocephaly - Webbed neck - Microstomia - Macrocheilia |
| See also non-congenital eye and ear | |
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
