Congenital nasolacrimal duct obstruction (dacryostenosis) and dacryocystocele
- Evelyn A Paysse, MD
Evelyn A Paysse, MD
- Section Editor — Pediatric Ophthalmology
- Professor of Ophthalmology and Pediatrics
- Baylor College of Medicine
- David K Coats, MD
David K Coats, MD
- Professor of Ophthalmology
- Baylor College of Medicine
Congenital nasolacrimal duct (NLD) obstruction (dacryostenosis) occurs in approximately 6 percent of newborns and is the most common cause of persistent tearing and ocular discharge in infants and young children. Most cases resolve spontaneously. Congenital dacryocystocele occurs less commonly, but is associated with potentially serious complications and hence requires urgent referral to an ophthalmologist.
The clinical features, evaluation, and management of congenital NLD obstruction and dacryocystocele will be discussed below. The anatomy of the lacrimal system, other causes of persistent tearing, and the approach to the child with persistent tearing are discussed separately. (See "Approach to the child with persistent tearing".)
Tears are produced by the main and accessory lacrimal glands and drain medially into the puncta, then flow through the canaliculi to the lacrimal sac, and then through the nasolacrimal duct (NLD) into the nose (figure 1). (See "Approach to the child with persistent tearing", section on 'Anatomy of the lacrimal system'.)
During embryonic development, the nasolacrimal apparatus appears in the third to fifth week and gradually forms a cord of epithelium that extends from the eyelids to the nose. Canalization of the cord begins at the punctum in the eyelid during the third month of intrauterine life and extends toward the nose. Canalization is usually complete by birth.
Congenital NLD obstruction and dacryocystocele are caused by obstructions at different locations in the nasolacrimal system:
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- NASOLACRIMAL DUCT OBSTRUCTION
- Epidemiology and natural history
- Clinical features
- Differential diagnosis
- Indications for referral
- - Nonsurgical management
- - Surgical management
- - Treatment failure
- - Acute dacryocystitis
- - Chronic dacryocystitis
- Clinical features
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS