Congenital Anomalies of the Nasolacrimal Duct Clinical Presentation

Updated: Aug 17, 2018
  • Author: Mounir Bashour, MD, PhD, CM, FRCSC, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
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See the list below:

  • Perinatal and pregnancy history

  • Family history of nasolacrimal duct problems, congenital glaucoma, or other congenital anomalies, especially facial (eg, cleft lip/palate)

  • History of other birth defects

  • Pediatric review of systems

  • To rule out congenital glaucoma, ask for history of tearing and photophobia, as well as increasing corneal size and clouding.



A complete ophthalmic assessment must be performed. A dye disappearance test is probably the single most useful test. Place a drop of fluorescein in each eye, and monitor with a cobalt blue light; if a pool is still present after 5 minutes, the test is positive, and the baby likely has some type of obstruction in the nasolacrimal system.

Measure corneal diameter, and, if suspicious, consider performing an intraocular pressure measurement. (See Glaucoma, Primary Congenital.)



Usually, these anomalies are sporadic, but genetics, prematurity, and maternal drug use can be possible influencing factors.

Ocular abnormalities are present in 20% of patients, and systemic abnormalities are present in almost 25% of patients with serious congenital nasolacrimal duct anomalies.