eMedicine Specialties > Ophthalmology > Lacrimal System

Nasolacrimal Duct, Congenital Anomalies: Treatment & Medication

Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Contributor Information and Disclosures

Updated: Jun 8, 2009

Treatment

Medical Care

Congenital nasolacrimal duct obstructions spontaneously resolve in 90% of cases during the first year of life. Some physicians have advocated massage with digital pressure as an aid to speeding up this natural resolution. Other than massage, topical antibiotics are useful for mucopurulent discharge, but the only treatment of efficacy for those patients who do not resolve spontaneously is surgery.

Surgical Care

  • Probing: Probing cures 95% of congenital nasolacrimal obstructions. Prognosis for probing decreases exponentially with the increasing number of probings and the age of the patient. Rarely, it is successful after the third time or after 3 years.
  • Nasolacrimal intubation: It has been advocated as an alternate procedure to dacryocystorhinostomy (DCR) in children who have failed probing.
    • Success rates of 80-95% have been reported, but most patients have only been probed twice or less and are younger than 2 years. Prognosis is poor for those patients with previous dacryocystitis and for those patients in which an obstruction is encountered during the procedure.
    • Lim et al noted that increasing the duration of intubation was not associated with increasing the chance of success but with a significantly higher risk of failure if longer than 18 months (P=0.03).3 The retention of stents for longer than 12 months was associated with a significantly lower success rate (67%). The presence of Down syndrome, older age at the time of surgery, and gender of the patient were not predictive factors for treatment failure. The unplanned removal of the tubes because of dislodgement was the most common complication, occurring in 25% of eyes, but did not affect the functional outcome.
  • Balloon catheter dilatation of the nasolacrimal system with or without silicone tubing: This procedure has slightly better results than intubation alone. Most probing failures occur as a result of upper sac or mid duct obstructions and are not amenable to cure by instrumentation. Repeat probing procedures and intubation can cause serious complications, including false passages, canalicular scarring, and stenosis.
  • DCR: This treatment is the criterion standard when a patent canalicular system is present. See Nasolacrimal Duct, Obstruction.
  • Conjunctival dacryocystorhinostomy: If the upper system is scarred or otherwise not amenable to opening, then it can be bypassed using a prosthesis, such as a Lester-Jones tube. This procedure probably should be avoided until the child is older than 10 years because the prosthesis does require care from the patient and often has minor complications and revisions. In punctal agenesis where no canalicular tissue can be identified, the insertion of a Lester-Jones tube is necessary.

Consultations

Pediatrician, genetics counselor, or maxillofacial surgeon

More on Nasolacrimal Duct, Congenital Anomalies

Overview: Nasolacrimal Duct, Congenital Anomalies
Differential Diagnoses & Workup: Nasolacrimal Duct, Congenital Anomalies
Treatment & Medication: Nasolacrimal Duct, Congenital Anomalies
Follow-up: Nasolacrimal Duct, Congenital Anomalies
References
[ CLOSE WINDOW ]

References

  1. Fimiani F, Iovine A, Carelli R, Pansini M, Sebastio G, Magli A. Incidence of ocular pathologies in Italian children with Down syndrome. Eur J Ophthalmol. Sep-Oct 2007;17(5):817-22. [Medline].

  2. Stephen E, Dickson J, Kindley AD, Scott CC, Charleton PM. Surveillance of vision and ocular disorders in children with Down syndrome. Dev Med Child Neurol. Jul 2007;49(7):513-5. [Medline].

  3. Lim CS, Martin F, Beckenham T. Nasolacrimal duct obstruction in children: outcome of intubation. J AAPOS. Oct 2004;8(5):466-72. [Medline].

  4. Bowling BS, Chandna A. Superior lacrimal canalicular atresia and nasolacrimal duct obstruction in the CHARGE association. J Pediatr Ophthalmol Strabismus. Sep-Oct 1994;31(5):336-7. [Medline].

  5. Busse H. [Connatal dacryostenoses. Clinical picture and treatment]. Ophthalmologe. Sep 2004;101(9):945-54; quiz 955-6. [Medline].

  6. Cahill KV, Burns JA. Management of epiphora in the presence of congenital punctal and canalicular atresia. Ophthal Plast Reconstr Surg. 1991;7(3):167-72. [Medline].

  7. Chronister CL, Lee A, Kaiser H. Rarely reported cases of congenital atresia of nasolacrimal puncta. Optometry. Apr 2002;73(4):237-42. [Medline].

  8. Foster JA, Katowitz JA, Heyman S. Results of dacryoscintigraphy in massage of the congenitally blocked nasolacrimal duct. Ophthal Plast Reconstr Surg. Mar 1996;12(1):32-7. [Medline].

  9. Holzberg N, Ward RF. Bilateral congenital dacrocystoceles. Otolaryngol Head Neck Surg. Dec 1993;109(6):1074-7. [Medline].

  10. Ingels K, Kestelyn P, Meire F, Ingels G, Van Weissenbruch R. The endoscopic approach for congenital nasolacrimal duct obstruction. Clin Otolaryngol Allied Sci. Apr 1997;22(2):96-9. [Medline].

  11. Lyon DB, Dortzbach RK, Lemke BN, Gonnering RS. Canalicular stenosis following probing for congenital nasolacrimal duct obstruction. Ophthalmic Surg. Apr 1991;22(4):228-32. [Medline].

  12. Lyons CJ, Rosser PM, Welham RA. The management of punctal agenesis. Ophthalmology. Dec 1993;100(12):1851-5. [Medline].

  13. McNab AA. Congenital absence of the nasolacrimal duct. J Pediatr Ophthalmol Strabismus. Sep-Oct 1998;35(5):294-5. [Medline].

  14. Paul TO, Shepherd R. Congenital nasolacrimal duct obstruction: natural history and the timing of optimal intervention. J Pediatr Ophthalmol Strabismus. Nov-Dec 1994;31(6):362-7. [Medline].

  15. Sevel D. Development and congenital abnormalities of the nasolacrimal apparatus. J Pediatr Ophthalmol Strabismus. Sep-Oct 1981;18(5):13-9. [Medline].

  16. Ugurbas SH, Zilelioglu G. Congenital lacrimal fistula. Eur J Ophthalmol. Jan-Mar 2000;10(1):22-6. [Medline].

  17. Welham RA, Hughes SM. Lacrimal surgery in children. Am J Ophthalmol. Jan 15 1985;99(1):27-34. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

nasolacrimal duct obstruction, nasolacrimal duct system, congenital nasolacrimal duct anomalies, nasolacrimal duct system abnormalities

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Gerhard W Cibis, MD, Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas, Kansas City
Gerhard W Cibis, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Ophthalmological Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching; Ortho-Neutrogenia Consulting fee Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.