Simple Congenital Nasolacrimal Duct Obstruction and Its Management

Abstract

Congenital nasolacrimal duct obstruction (CNLDO) is a common cause of epiphora in children with incidence of symptoms ranging from 1.2 to 30% [1–5]. In a simple CNLDO, there is a lack of resistance in passing probe through the NLD until a point of membranous obstruction which can be perforated [5]. The characteristic triad includes watering, discharge, and matting of eyelashes. The onset of epiphora is usually within first month of age. Condition can be unilateral or bilateral. Symptoms may worsen with occurrence of upper respiratory tract infection. Other signs include increased tear meniscus height, positive fluorescein dye disappearance test (FDDT), and regurgitation on pressure over lacrimal sac (ROPLAS). Spectrum of presentation can rarely include acute dacryocystitis, dacryocele, mucopyocele, preseptal, and orbital cellulitis. Management of CNLDO is principally guided by natural history of disease and high spontaneous remission rate by 1 year of age [1–5]. Hence conservative measures like lacrimal sac compression are usually employed initially. The standard of care for non-resolving cases is endoscopic-assisted probing with or without intubation. There is an increasing role of dacryoendoscopy and simultaneous correction of associated intranasal abnormalities. Balloon dacryoplasty and dacryocystorhinostomy also have their specific indications in refractory CNLDO.