Congenital Nasolacrimal Duct Obstruction

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Disease

  • Normally, the nasolacrimal duct is fully canalised shortly after birth; in about 20% of newborns, the valve of Hasner does not open
  • In 95% of cases, stenoses spontaneously resolve within the first year of life.

Differential diagnoses

  • Tears due to congenital glaucoma

Management

  • Tear duct massage: increases hydrostatic pressure and may rupture the valve of Hasner. The index finger should be placed over the common canaliculus to prevent reflux through the tear ducts and then firmly massaged downwards
  • Try Rhinosedin 0.05% (nasal) drops or Nasivin 0.025% in the eye 3x/d for 2 weeks + local antibiotics (e.g. Spersapolymyxin gtt 3x/d) in case of secretion/inflammation
  • Tear duct irrigation and if necessary probing under general anaesthesia
    • Wait until the patient is about 12 months old, as the rate of spontaneous healing is high
    • If there is no improvement, consider repeating the probing or inserting a silicone tube
    • Postoperatively Rhinosedin 0.05% (nasal) drops 3x/d and Polyspectran gtt or Spersapolymyxin gtt 3x/d both into the eye for 1 week after irrigation, if necessary up to 3 weeks after probing

Sources

  • EyeWiki Nasolacrimal Duct Obstruction
  • AAO Disease Review
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Kalla Gervasio MD, Travis Peck MD et al; Lippincott Williams&Wilkins; 8th Edition (2021)
  • Kanski‚Äôs Clinical Ophthalmology: A Systematic Approach; John E Salmon MD; Elsevier; 9th Edition (2019)