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Congenital Nasolacrimal Duct Obstruction

Congenital Nasolacrimal Duct Obstruction 

“Promises are like crying babies in a theatre. They should be carried out immediately!” – Norman Vincent Peale
A crying baby drives everyone to despair… Colic, hunger, dirty diaper or just boredom? Sometimes you just don’t know! Did you know that there are times when a baby has tears in his eyes for the simple reason that his eyes cannot retain them?
 

What is congenital nasolacrimal duct obstruction?

This refers to the obstruction to the passage of tears since birth. Normally the tears produced within the eye get drained via a tube to the nose. However in this condition there occurs a blockage of this tube causing watering of the eyes. This is seen in about 2-4% of all new born babies. The block can be on one or both the sides.

 

 

What causes congenital nasolacrimal duct obstruction?

The most common cause of congenital nasolacrimal duct obstruction is a membrane which blocks the lower end of the nasolacrimal duct. (This membrane is present in all babies while they are in the womb and disappears by eight months of life in the womb). General narrowing of the duct is the most common cause. Other causes include mal-development of the opening/ duct/ lacrimal sac or development of a fluid filled sac (called as a mucoele or dacrocystocele).
 

Does my child have congenital nasolacrimal duct obstruction? (Signs and Symptoms)

• There occurs watering of eyes with matting of lashes which may or may not be associated with discharge. This develops within 6 weeks of birth. Due to the discharge, there may be stickiness of eyes or crusting of eyelids.
• Sometimes there may occur a boggy swelling on the side of the nose (in the lacrimal sac area).
• Application of pressure in the sac area may cause regurgitation of fluid from the puncta (small pin point openings on the lid).

 

 

What are the tests for congenital nasolacrimal duct obstruction?

While proper history and thorough examination help the doctor to make a diagnosis, the following test helps in confirming the diagnosis:

Fluorescein Dye Disappearance Test: A drop of a dye called fluorescein is added to the eye and its disappearance is observed after 5 minutes. If the dye is retained in a tear strip, an obstruction is diagnosed.
 

What is the treatment for congenital nasolacrimal duct obstruction?

Majority of these children get cured by properly done massage and antibiotic eye drops.

 

 

In few children in whom the condition doesn’t get better by one year of age with massage, a cleaning procedure called probing is done in which a thin metallic probe is passed through the tear duct to open the passage.

In complex cases surgical intervention is required in the form of dacryocystirhinostomy in which a surgical passage is created between the tear sac and the nose which is generally done after 3 years of age.

What are the complications of congenital nasolacrimal duct obstruction?

• Conjunctivitis: This is the most common complication seen.
• Mucocele: This is seen when amniotic fluid enters the sac and cannot be drained due to the duct being closed at one end.
• Acute dacrocystitis: This is inflammation of the lacrimal sac due to the fluid being retained. It may also get infected.
 

What is the likely outcome of congenital nasolacrimal duct obstruction? (Prognosis)

About 90-96% of children see a spontaneous recovery within one year. Of the remaining children, 60% regain patency on their own by 2 years of age. The success rates of simple probing are rather excellent. The prognosis by either of the surgical procedures is also quite good.