Congenital nasolacrimal duct obstruction ( NLDO )

The symptoms of congenital nasolacrimal duct obstruction develop in 6-20% of infants during their first month of life. The parents may observe watering from the eye as well as maceration of the skin of the eyelids, sticky eyes, crusting of the eyelids and local infections, such as conjunctivitis. (1)

Spontaneous resolution occurs in the vast majority of cases. Without treatment, less than 1% of infants will still be affected by their first birthday and in most cases, simple massaging of the ducts may be enough because of the high rate of spontaneous resolution. Consider the differential diagnosis of congenital lacrimal duct obstruction e.g. any lash or lid abnormality. (2)

Treatment options are either conservative - including observation (or deferred probing), massage of the lacrimal sac, and antibiotics - or probing the nasolacrimal duct to open the membranous obstruction at the distal nasolacrimal duct. (3)

The use of antibiotics should be minimised. Hospital referral is indicated if symptoms are still present at 12 months. (4)

Reference

1. Petris C, Liu D; Probing for congenital nasolacrimal duct obstruction. Cochrane Database Syst Rev. 2017 Jul 12;7:CD011109.
2. Vagge A, Ferro Desideri L, Nucci P, et al; Congenital Nasolacrimal Duct Obstruction (CNLDO): A Review. Diseases. 2018 Oct 22;6(4)
3. Resolution of congenital nasolacrimal duct obstruction with nonsurgical management; Arch Ophthalmol. 2012 Jun;130(6):730-4.
4. Nasolacrimal duct obstruction (nasolacrimal drainage dysfunction); College of Optometrists, March 2016