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:
- Örge FH, Boente CS. The lacrimal system. Pediatr Clin North Am 2014; 61:529.
- Olitsky SE. Update on congenital nasolacrimal duct obstruction. Int Ophthalmol Clin 2014; 54:1.
- Maini R, MacEwen CJ, Young JD. The natural history of epiphora in childhood. Eye (Lond) 1998; 12 ( Pt 4):669.
- MacEwen CJ, Young JD. Epiphora during the first year of life. Eye (Lond) 1991; 5 ( Pt 5):596.
- Petersen RA, Robb RM. The natural course of congenital obstruction of the nasolacrimal duct. J Pediatr Ophthalmol Strabismus 1978; 15:246.
- Pediatric Eye Disease Investigator Group. Resolution of congenital nasolacrimal duct obstruction with nonsurgical management. Arch Ophthalmol 2012; 130:730.
- Pediatric Eye Disease Investigator Group. A randomized trial comparing the cost-effectiveness of 2 approaches for treating unilateral nasolacrimal duct obstruction. Arch Ophthalmol 2012; 130:1525.
- Piotrowski JT, Diehl NN, Mohney BG. Neonatal dacryostenosis as a risk factor for anisometropia. Arch Ophthalmol 2010; 128:1166.
- Kushner BJ. Congenital nasolacrimal system obstruction. Arch Ophthalmol 1982; 100:597.
- Schnall BM. Pediatric nasolacrimal duct obstruction. Curr Opin Ophthalmol 2013; 24:421.
- Robb RM. Probing and irrigation for congenital nasolacrimal duct obstruction. Arch Ophthalmol 1986; 104:378.
- Katowitz JA, Welsh MG. Timing of initial probing and irrigation in congenital nasolacrimal duct obstruction. Ophthalmology 1987; 94:698.
- el-Mansoury J, Calhoun JH, Nelson LB, Harley RD. Results of late probing for congenital nasolacrimal duct obstruction. Ophthalmology 1986; 93:1052.
- Miller AM, Chandler DL, Repka MX, et al. Office probing for treatment of nasolacrimal duct obstruction in infants. J AAPOS 2014; 18:26.
- Pediatric Eye Disease Investigator Group, Repka MX, Chandler DL, et al. Primary treatment of nasolacrimal duct obstruction with probing in children younger than 4 years. Ophthalmology 2008; 115:577.
- Frick KD, Hariharan L, Repka MX, et al. Cost-effectiveness of 2 approaches to managing nasolacrimal duct obstruction in infants: the importance of the spontaneous resolution rate. Arch Ophthalmol 2011; 129:603.
- Pediatric Eye Disease Investigator Group, Repka MX, Chandler DL, et al. Repeat probing for treatment of persistent nasolacrimal duct obstruction. J AAPOS 2009; 13:306.
- Repka MX, Chandler DL, Holmes JM, et al. Balloon catheter dilation and nasolacrimal duct intubation for treatment of nasolacrimal duct obstruction after failed probing. Arch Ophthalmol 2009; 127:633.
- Pediatric Eye Disease Investigator Group, Repka MX, Melia BM, et al. Primary treatment of nasolacrimal duct obstruction with nasolacrimal duct intubation in children younger than 4 years of age. J AAPOS 2008; 12:445.
- Engel JM, Hichie-Schmidt C, Khammar A, et al. Monocanalicular silastic intubation for the initial correction of congenital nasolacrimal duct obstruction. J AAPOS 2007; 11:183.
- Pediatric Eye Disease Investigator Group, Repka MX, Melia BM, et al. Primary treatment of nasolacrimal duct obstruction with balloon catheter dilation in children younger than 4 years of age. J AAPOS 2008; 12:451.
- Campolattaro BN, Lueder GT, Tychsen L. Spectrum of pediatric dacryocystitis: medical and surgical management of 54 cases. J Pediatr Ophthalmol Strabismus 1997; 34:143.
- Baskin DE, Reddy AK, Chu YI, Coats DK. The timing of antibiotic administration in the management of infant dacryocystitis. J AAPOS 2008; 12:456.
- Hussein M, Miller AM, Steinkuller PG. Ocular infections. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th ed, Cherry JD, Harrison GJ, Kaplan SL, et al (Eds), Elsevier Saunders, Philadelphia 2014. p.794.
- Kuchar A, Lukas J, Steinkogler FJ. Bacteriology and antibiotic therapy in congenital nasolacrimal duct obstruction. Acta Ophthalmol Scand 2000; 78:694.
- Paysse EA, Coats DK, Bernstein JM, et al. Management and complications of congenital dacryocele with concurrent intranasal mucocele. J AAPOS 2000; 4:46.
- Wong RK, VanderVeen DK. Presentation and management of congenital dacryocystocele. Pediatrics 2008; 122:e1108.
- Edmond JC, Keech RV. Congenital nasolacrimal sac mucocele associated with respiratory distress. J Pediatr Ophthalmol Strabismus 1991; 28:287.
- Duval M, Alsabah BH, Carpineta L, Daniel SJ. Respiratory distress secondary to bilateral nasolacrimal duct mucoceles in a newborn. Otolaryngol Head Neck Surg 2007; 137:353.
- Yee SW, Seibert RW, Bower CM, Glasier CM. Congenital nasolacrimal duct mucocele: a cause of respiratory distress. Int J Pediatr Otorhinolaryngol 1994; 29:151.
- Leonard DS, O'Keefe M, Rowley H, Hughes JP. Neonatal respiratory distress secondary to bilateral intranasal dacryocystocoeles. Int J Pediatr Otorhinolaryngol 2008; 72:1873.
- 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