Paediatric
Congenital Nasolacrimal Duct Obstruction
Also known as: CNLDO, blocked tear duct baby, epiphora in infant, watery eye infant, nasolacrimal duct obstruction, sticky eye newborn, Hasner's membrane, lacrimal probing
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
The most common cause of watering and discharge in infants. Present in approximately 6% of newborns due to failure of Hasner's membrane to open at the lower end of the nasolacrimal duct. The majority resolve spontaneously by 12 months. Conservative management with massage and topical antibiotics for secondary infection is first-line.
Recognition
Symptoms: what patients report
- Persistent watering (epiphora) from birth or within the first few weeks of life.
- Mucopurulent or sticky discharge on the lashes, especially on waking.
- Repeated episodes of conjunctival redness with mucopurulent discharge.
- Parents often report the eye is 'always watery' or 'always sticky'.
- Unilateral in approximately 70% of cases; can be bilateral.
Signs: what the examination shows
- Epiphora with a full or elevated tear meniscus.
- Mucopurulent discharge collecting at the lid margins.
- Reflux of mucus from the punctum on compression of the lacrimal sac (in dacryocystocele or chronic obstruction).
- Normal slit lamp (or anterior segment) examination otherwise.
- Dacryocystocele: a blue-grey, fluctuant swelling at the medial canthus from birth — indicates an amniotic fluid-filled distended sac.
What OptoGuide™ covers for congenital nasolacrimal duct obstruction
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Congenital Nasolacrimal Duct Obstruction — EyeWiki
- Nasolacrimal duct obstruction — College of Optometrists CMG
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Probing for Congenital Nasolacrimal Duct Obstruction. Petris C, Liu D. The Cochrane Database of Systematic Reviews. 2017;7:CD011109.
- Ocular Disorders in the Newborn. Mehner LC, Singh JK. NeoReviews. 2021;22(7):e461-e469.
- Acute dacryocystitis: changing practice pattern over the last three decades at a tertiary care setup. Gupta A, Saini P, Bothra N, Ali MJ. Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefe
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.