Overview of the management of infants with symptomatic congenital nasolacrimal duct obstruction (blocked tear duct)
Overview of the management of infants with symptomatic congenital nasolacrimal duct obstruction (blocked tear duct)
This figure summarizes the general approach to management of infants with symptomatic CNLDO. Symptoms of CNLDO include chronic or intermittent tearing and debris on the eyelashes ("mattering"). This algorithm is intended for use in conjunction with other UpToDate content. Refer to UpToDate's topic on CNLDO for additional details, including the evidence supporting the efficacy of these interventions.
NLD: nasolacrimal duct; GA: general anesthesia; CNLDO: congenital nasolacrimal duct obstruction.
* Lacrimal sac massage is performed by applying moderate pressure over the lacrimal sac in a downward direction for 2 to 3 seconds. Caregivers are instructed to perform this maneuver 2 to 3 times per day until symptoms resolve.
¶ If recurrent symptoms occur after the age of 6 months, referral to an ophthalmologist is warranted.
Δ Anisometric amblyopia occurs in approximately 10% of patients with unilateral CNLDO.
◊ NLD probing is typically performed in the office with local anesthesia in infants <12 months of age and weighing <9 kg; whereas it is generally performed in the operating room under GA in children ≥12 months old or weighing ≥9 kg. Other NLD procedures (NLD intubation, balloon dacryoplasty, dacryocystorhinostomy, and conjunctivodacryocystorhinostomy) are performed in the operating room under GA. Refer to UpToDate's topic on CNLDO for details regarding the choice of surgical procedure.
