History
Patient history should include the following:
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Perinatal and pregnancy history
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Family history of nasolacrimal duct problems, congenital glaucoma, or other congenital anomalies, especially facial (eg, cleft lip/palate)
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History of other birth defects
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History of prematurity
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Pediatric review of systems
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To rule out congenital glaucoma, ask for history of tearing and photophobia, as well as increasing corneal size and clouding.
Physical
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.
Palpating the lacrimal sac may result in tears and/or mucoid discharge refluxing onto the eye through the puncta.
Measure corneal diameter, and, if suspicious, consider performing an intraocular pressure measurement. (See Glaucoma, Primary Congenital.)
Causes
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.
Complications
Neonatal dacryocystocele
Approximately 3% of infants with NLDO present in the neonatal period with a dacryocystocele. Dacryocystoceles are clinically important for two reasons. First, if the nasolacrimal duct cysts are large, they may cause respiratory problems in newborns. The second important clinical problem in these patients is the potential for acute lacrimal infection. Because infants are relatively immunocompromised in the first few months of life, these infections have the potential to spread, causing serious problems such as orbital cellulitis, meningitis, or sepsis. Prompt treatment of these infected dacryocystoceles is indicated. [8]
