Congenital obstruction of the nasolacrimal duct (congenital nasolacrimal duct obstruction, CNLDO) is relatively common in young infants.


Possible causes of congenital obstruction to the nasolacrimal duct:

(1) stenosis of the duct

(2) atresia

(3) agenesis

(4) duplication

(5) membranous obstruction at the distal end

(6) congenital dacrocystitis


Clinical features:

(1) watery discharge from the eye down the cheek (tearing, epiphora), usually unilateral but sometimes bilateral

(2) onset of discharge within first few weeks after delivery

(3) presence of a tear meniscus at the medial canthus

(4) mucocele at the medial canthus


Occasional findings:

(1) some patients develop an intermittent mucopurulent discharge

(2) some patients develop intermittent conjunctivitis

(3) crusting on lashes may be present


Notably absent:

(1) signs of active infection

(2) photophobia

(3) signs of irritation


Spontaneous resolution suggests a membranous obstruction that has perforated.


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