Date of last review: Due to be updated

Differential diagnosis

  • Congenital glaucoma (buphthalmos and corneal clouding)
  • Punctal atresia
  • Congenital

Possible management by Optometrist

  • Fluorescein disappearance test
    • A drop of 1% fluorescein should disappear from the tear meniscus in 5-10 minutes (cobalt blue light, room lights off); any longer suggests partial or complete obstruction
    • Look up nose for presence of fluorescein to confirm patency

Treatment

  • Do not syringe or probe
  • Instruct parent in massage
    • Gentle pressure with finger over common canaliculus, stroking downwards firmly to raise pressure in lacrimal sac and encourage opening of valve
    • Suggest ten strokes, twice daily
    • Regular cleaning of discharge from lids

Advice

  • High rate of spontaneous resolution during the first 12 months of life

Management Category

  • Alleviation or palliation; normally no referral
  • Refer for probing if condition fails to resolve by 12 months (>50% resolve within 6 months, 70% by 12 months)

Possible management by Ophthalmologist

  • None until 12 months of age to allow for spontaneous canalisation
  • Lacrimal syringing
  • Probing