Pediatric Nasolacrimal Duct Obstruction

  • Rona Z. SilkissEmail author


Pediatric (congenital) nasolacrimal duct obstruction (PNLDO) is the most common cause of persistent epiphora in childhood. The incidence of PNLDO is 5–6% (ranging from 1.2 to 30%) of births. Spontaneous resolution is reported in 90% within the first year of life. Our treatments are geared to the 10% of patients that do not experience spontaneous resolution. This chapter discusses the typical presentation of the tearing patient as well as the differential diagnosis. The traditional therapeutic paradigm including primary probing, secondary probing with stent, choice of stent, and dacryocystorhinostomy is discussed with recent data to inform decision-making.


Pediatric nasolacrimal duct obstruction Nasal lacrimal duct probing Monocanalicular intubation Bicanalicular intubation Balloon dacryoplasty Endoscopic dacryocystorhinostomy External dacryocystorhinostomy 

Supplementary material

419986_5_En_8_MOESM1_ESM.mp4 (8.5 mb)
Video 8.1 Nasolacrimal duct obstruction probing. Video courtesy of Dr. Angela Dolmetsch (MP4 5596 kb)
419986_5_En_8_MOESM2_ESM.mp4 (155.4 mb)
Video 8.2 Probing and stenting. Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 159146 kb)
419986_5_En_8_MOESM3_ESM.mp4 (95.5 mb)
Video 8.3 Probing and stenting of nasolacrimal duct with fluorescein irrigation. Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 97811 kb)
419986_5_En_8_MOESM4_ESM.mp4 (101.9 mb)
Video 8.4 Endoscopic retrieval of Crawford stent. Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 104346 kb)
419986_5_En_8_MOESM5_ESM.mp4 (103.2 mb)
Video 8.5 Options for retrieving Crawford stents. Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 105629 kb)
419986_5_En_8_MOESM6_ESM.mp4 (20.5 mb)
Video 8.6 Inferior turbinate infracture. Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 21024 kb)
419986_5_En_8_MOESM7_ESM.mp4 (47.1 mb)
Video 8.7 Intranasal cyst in congenital nasolacrimal duct obstruction (NLDO). Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 48251 kb)
419986_5_En_8_MOESM8_ESM.mp4 (2.9 mb)
Video 8.8 Endoscopic dacryocystorhinostomy. Video by Dr. Rona Z. Silkiss. (MP4 2999 kb)
419986_5_En_8_MOESM9_ESM.mp4 (257.6 mb)
Video 8.9 External dacryocystorhinostomy. Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 263826 kb)


  1. 1.
    Schnall BM. Pediatric nasolacrimal duct obstruction. Curr Opin Ophthalmol. 2013;24(5):421–4.CrossRefPubMedGoogle Scholar
  2. 2.
    Medghalchi A, Mohammadi MJ, Soltani Moghadam R, Dalili H. Results of nasolacrimal duct probing in children between 9–48 months. Acta Med Iran. 2014;52(7):545–51.PubMedGoogle Scholar
  3. 3.
    Engel JM, Hatchie-Schmidt C, Khammar A, Ostfeld BM, Vyas A, Ticho BH. Monocanalicular silastic intubation for the initial correction of congenital nasolacrimal duct obstruction. JAAPOS. 2007;11(2):183–6.Google Scholar
  4. 4.
    Pediatric Eye Disease Investigator Group, Repka MX, Melina BM, Beck RW, Atkinson CS, Chandler DL, Holmes JM, Khammar A, Morrison D, Quinn GE, Silbert DI, Ticho BH, Wallace DK, Weakley DR Jr. Primary treatment of nasolacrimal duct obstruction with nasolacrimal duct intubation in children younger than 4 years of age. J AAPOS. 2008;12(5):445–50.CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Pediatric Eye Disease Investigator Group, Repka MX, Melia BM, Beck RW, Chandler DL, Fishman DR, Goldblum TA, Holmes JM, Perla BD, Quinn GE, Silbert DI, Wallace DK. Primary treatment of nasolacrimal duct obstruction with balloon catheter dilation in children younger than 4 years of age. J AAPOS. 2008;12(5):451–5.CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Repka MX, Chandler DL, Holmes JM, Hoover DL, Morse CL, Schloff S, Silbert DI, Tien DR, Pediatric Eye Disease Investigator Group. Balloon catheter dilation and nasolacrimal duct intubation for treatment of nasolacrimal duct obstruction after failed probing. Arch Ophthalmol. 2009;127(5):633–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Pediatric Eye Disease Investigator Group. A randomized trial comparing the cost-effectiveness of 2 approaches for treating unilateral nasolacrimal duct obstruction. Arch Ophthalmol. 2012;130(12):1525–33.CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Ozgur OR, Sayman IB, Oral Y, Akmaz B. Prevalence of amblyopia in children undergoing nasolacrimal duct irrigation and probing. Indian J Ophthalmol. 2013;61(12):698–700.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Eshraghi B, Akbari MR, Fard MA, Shahsanaei A, Assari R, Mirmohammadsadeghi A. The prevalence of amblyogenic factors in children with persistent congenital nasolacrimal duct obstruction. Graefes Arch Clin Exp Ophthalmol. 2014;252(11):1847–52.CrossRefPubMedGoogle Scholar
  10. 10.
    Kipp MA, Kipp MA Jr, Struthers W. Anisometropia and amblyopia in nasolacrimal duct obstruction. J AAPOS. 2013;17(3):235–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Matta NS, Silbert DI. High prevalence of amblyopia risk factors in preverbal children with nasolacrimal duct obstruction. J AAPOS. 2011;15(4):350–2.CrossRefPubMedGoogle Scholar
  12. 12.
    Celenk F, Mumbuc S, Durucu C, Karatas ZA, Aytaç I, Baysal E, Kanlikama M. Pediatric endonasal endoscopic dacryocystorhinostomy. Int J Pediatr Otorhinolaryngol. 2013;77(8):1259–62.CrossRefPubMedGoogle Scholar
  13. 13.
    Dolmetsch AM, Gallon MA, Holds JB. Nonlaser endoscopic endonasal dacryocystorhinostomy with adjunctive mitomycin C in children. Ophthal Plast Reconstr Surg. 2008;24(5):390–3.CrossRefPubMedGoogle Scholar
  14. 14.
    Donahue SP. Relationship between anisometropia, patient age, and the development of amblyopia. AJO. 2006;142(1):132–40.Google Scholar
  15. 15.
    Katowitz JA, Welsh MG. Timing of initial probing and irrigation in congenital nasolacrimal duct obstruction. Ophthalmology. 1987;94:698–705.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Ophthalmic Plastic, Reconstructive and Orbital SurgeryCalifornia Pacific Medical CenterSan FranciscoUSA
  2. 2.Silkiss Eye SurgeryOaklandUSA

Personalised recommendations