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A 2-month-old infant is brought to consultation by its parents who report epiphora, that is, excessive tearing, as well as mucous discharge from the eye since the second week of life.
What is congenital nasolacrimal duct obstruction?
Congenital nasolacrimal duct obstruction (CNLDO) is a common problem in the early years of life and one of the main causes of epiphora in infants,1 with an estimated incidence that varies widely (1.2% to 30%), depending on the diagnostic criteria used.2 It is thought to result from a delay in maturation of the nasolacrimal outflow system and, in particular, a failure of its canalisation process, more commonly at its lower end. It can be unilateral or bilateral.2 ,3
How does the child present?
Apart from the watery eye due to tear drainage failure, typically appearing in the first 2–4 weeks of life, the main other sign is mucous discharge. This discharge can be either constant or intermittent, and can be associated with skin redness and excoriation around the eye, as well as stickiness of the child's lids and lashes following sleep. Frequent attacks of conjunctivitis, with mucopurulent discharge and red eye, often complicate the condition. If more severe infection occurs, there may be chronic or recurrent bacterial blepharitis, or dacryocystitis, that is, mucopurulent discharge from the eye, with redness and warmth of the skin over the lacrimal sac. The latter can, if uncontrolled, lead to orbital cellulitis.3
A rare clinical picture you should be aware of
A rare variant of CNLDO, accounting for just 0.1% of cases, and regarded by some as a complication, is the development of a mucocele or dacryocystocele.2 ,3 This is formation of a dilated part of the lacrimal sac/duct, as a consequence of simultaneous proximal and distal obstruction. Its typical presentation is a bluish, cystic, firm mass below the medial canthus. Its clinical significance lies in the fact that if a cystic …
Competing interests None.
Provenance and peer review Commissioned; externally peer reviewed.