Pediatric nasolacrimal duct obstruction a review of current management

Congenital nasolacrimal duct obstruction is a condition that occurs commonly in infants22-25 and usually resolves with conservative management alone24-20. It is the most common cause of epiphora in infants1,2 70% of neonates present with congenital nasolacrimal duct obstructions at delivery3 with only 6-20% being symptomatic4,5 as the obstruction usually resolves before lacrimal secretion begins.6 The common approach in the management of this condition is lacrimal massage and observation with or without topical antibiotic treatment as most cases of nasolacrimal duct obstruction resolve without surgery.7−11 Another option is an immediate office probing approach with topical anaesthesia and restraint and this was not found to be superior to observation and massage.12 The assessment of pediatric epiphora involves looking for a high tear meniscus, recurrent mucopurulent discharge and applying pressure to the lacrimal sac contents by pressure to reflex the contents.6,13 Other conditions which may present with epiphora need to be excluded including epiblepharon, congenital entropion, congenital glaucoma, keratitis and uveitis.5 The fluorescent dye disappearance test is a non invasive test that can confirm nasolacrimal duct obstruction with 90% sensitivity8. Down’s syndrome and craniofacial malformations may be associated with a higher prevalence of congenital nasolacrimal duct obstruction which can be confirmed with imaging.9