Congenital Dacryocystitis (Congenital NLDO)
Pediatric Ophthalmology: Nasolacrimal Duct Obstruction
1. Pathophysiology
Congenital dacryocystitis is most commonly caused by a failure of the Valve of Hasner (distal end of the nasolacrimal duct) to canalize at the time of birth. This obstruction leads to stasis of tears, secondary bacterial colonization, and potential infection.
2. Clinical Features
| Symptom | Clinical Characteristic |
|---|---|
| Chronic Epiphora | Watery, tearing eyes were noted by parents shortly after birth. |
| Discharge | Mucopurulent discharge, particularly noticeable upon waking. |
| Crusting | Matted eyelashes; inflammation is typically mild unless acute infection supervenes. |
3. Management & High-Yield Pearls
- Conservative Approach: Most cases (over 90%) resolve spontaneously within the first year of life. Use “Crigler massage” (hydrostatic pressure over the lacrimal sac) to help open the obstruction.
- Surgical Intervention: Indicated if symptoms persist beyond 12 months, or earlier if severe/recurrent infections occur. Initial surgery is usually nasolacrimal duct probing.
- Diagnostic Note: Differentiate from congenital glaucoma (look for photophobia, tearing, and an enlarged/hazy cornea—the “buphthalmos” triad).
- Educational Resource: For pediatric probe timing, massage technique illustrations, and clinical practice questions, visit mymedschool.org.