Congenital nasolacrimal duct obstruction

Usually due to persistent membrane at the valve of Hasner

Clinical features

• Systemically well
• Inflamed/excoriated periorbital skin
• White eye
• Thickened tear meniscus (2mm or more)
• Crusting of lashes
• May be complicated by mucoceole or conjunctivitis

Tests

• Positive fluorescein dye disappearance test

Management

• Over 90% will resolve spontaneously within 1 year
• Conservative measures: Crigler massage, topical antibiotics only for complicating conjunctivitis
• Syringing and probing: if persists beyond 1 year
• +/- silicone stenting if probing fails: these remain in situ for 6 months and some residual tearing may continue
• Dacryocystorhinostomy: if above fails