Nasolacrimal Duct Obstruction in Infants When Conservative Measures Have Not Resolved Epiphora
In infants with nasolacrimal duct obstruction, spontaneous resolution during the first months of life is common. When first-line conservative management has been undertaken and persistent epiphora or periocular discharge remains, a structured next-step approach is warranted to restore nasolacrimal duct patency.
Previous Treatment & Failure Condition
Initial conservative management — including digital massage of the lacrimal sac and, where significant discharge is present, topical antibiotics — targets resolution of epiphora and periocular discharge. When spontaneous improvement does not occur and these goals remain unmet, escalation beyond conservative measures is indicated.
Next-Step Intervention (Partial Overview)
The next stage involves a targeted procedural intervention directly addressing the ductal obstruction. The clinical goal is patency of the nasolacrimal duct. The complete technique, including procedural steps, optional adjuncts, and setting considerations, is detailed in the full protocol.
References
- If children do not improve with time and conservative measures, surgical treatment is indicated.
- Whether done in the office or the operating room, this is achieved by passing a probe through the punctum, along the canaliculus to the lacrimal sac, and down into the nares.
- Most practitioners perform some sort of irrigation using a cannula after probing to ensure patency of the duct.
- The inferior turbinate can be infractured to increase the space where the NLD exits into the nares.
- The use of vasoconstrictors such as oxymetazoline can decrease bleeding during the procedure.
- They may be applied either directly via a soaked pledget or by nasal spray.
View source ↗