View source for Congenital lacrimal duct obstruction

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'''Congenital nasolacrimal duct obstruction''' (CLDO) is literally a [[lacrimal duct|tear duct]] that has failed to open at the time of birth. Around 6% of infants have CLDO, usually experiencing a persistent watery eye even when not crying.  If a secondary infection occurs, purulent (yellow / green) discharge may be present. 
 
Most cases resolve spontaneously, with [[antibiotic]]s reserved only if [[conjunctivitis]] occurs. Lacrimal sac massage has been proposed as helping to open the duct, though this is not always successful.{{ref|BMJ1997}}  The aim of massage is to generate enough hydrostatic pressure (downward, toward the nose) to "pop" open any obstruction.  Additional massage may then be performed up toward the [[lacrimal punctum]], in order to express any infectious material out of the [[nasolacrimal sac]].  When discharge or crusting is present, the lids should be gently cleaned using cooled pre-boiled water or saline. 

Referral to an [[ophthalmologist]] is indicated if symptoms are still present at 12 months, or sooner if significant symptoms or recurrent infections occur.  [[Nasolacrimal duct probing]] may be performed in the office setting (usually from 4 to 8 months of age) or under general anesthesia in an operating room for older patients.  The success rate of probing is higher for younger children.  A [[silastic]] tube or [[stent]] may be employed along with probing to maintain tear duct patency {{ref|JAAPOS2007}}.

==References==
#{{note|BMJ1997}} Young JD, MacEwen CJ., Managing congenital lacrimal obstruction in general practice. BMJ. 1997 Aug 2;315(7103):293-6. [http://bmj.bmjjournals.com/cgi/content/full/315/7103/293 Article] PMID 9274552

#{{note|JAAPOS2007}} Engel JM, Hilchie-Schmidt C, Khammar A, Ostfeld BM, Vyas A, Ticho BH: Monocanalicular silastic intubation for the initial correction of congenital nasolacrimal duct obstruction.  JAAPOS. 2007 Apr;11:183-6. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed] PMID 17307001

==See also==
*[[Lacrimal apparatus]]
*[[Nasolacrimal duct]]

{{Congenital malformations and deformations of eye, ear, face and neck}}
{{Eye pathology}}

[[Category:Ophthalmology]]
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[[nl:Dacryostenose]]

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