MODERN MEDICINE OPHTHALMOLOGY CLINIC Blocked tear ducts GLEN A GOLE, MD BS, FRACO, FRACS, FROCOphth Blocked tear ducts are common in newborns. Two percent of children will develop symptoms, usually epiphora or mild recurrent conjunctivitis. Treatment usually involves massaging the lacrimal sac to promote spontaneous cure. Probing is indi- cated in children with recurrent infections or with epiphora that is particularly troublesome. ^ Blockage of the nasolacrimal duct usually presents in the first few months of life as epiphora (watering eyes — see Figure 1) or as recurrent conjunctivitis. The nasolacrimal duct, which connects the lacrimal sac to the nasal cavity, begins to form by about the sixth week of gesta- tion and canalises from the sixth month. Thirty percent of newborns wiU have anatomical- ly blocked tear ducts at birth. Symptoms will be produced in only about 2% of children. Dr Gold is visiting ophthalmologist. Royal Children's and Royal Women's Hospitals, consultant ophthalmologist, Paediatric Low Vision Clinic, and Clinical Associate Professor, University of Queensland, Brisbane, Queensland, Australia. Differential diagnosis Blockage of the nasolacrimal duct is not the only cause of watering eyes in infancy. Do not forget to exclude corneal disease, for example, a corneal foreign body or an ulcer. Congenital glaucoma occasion- ally presents as a watering eye and is often associated with photophobia. An eye with con- genital glaucoma often has an enlarged cornea with a 'grovmd glass' appearance. The possibil- ity of ophthalmia neonatorum should also be considered in any neonate with a purulent discharge from the eyes. Figure 1. An infant with blocked tear ducts showing epiphora How do I treat blocked tear ducts? The usual treatment in cases that are not infected is to mas- sage the lacrimal sac (see page 106). Massage of the lacrimal sac has been shown to result in a higher rate of spontaneous Lacrimal gland Superior canaliculus Common canaliculus Secretory ducts Inferior canaliculus Nasolacrimal duct' Inferior meatus- Inferior turbinate Figure 2. Anatomy of the lacrimal drainage system Figure 3. Technique of massage of the lacrimal sac OCTOBER 1994 / MODERN MEDICINE OF SOUTH AFRICA 103 Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2012)
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