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Nasolacrimal duct obstruction: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
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Nasolacrimal duct obstruction is a condition better called delayed recovery of nasolacrimal duct patency, as it often resolves spontaneously. The lower part of the nasolacrimal duct (the valve of Hasner) is the last part of the lacrimal drainage system to recover patency. Complete recovery of patency usually occurs immediately after birth. However, almost 20% of children show signs of nasolacrimal duct obstruction in the first year of life.
[ Symptoms of nasolacrimal duct obstruction
- Tearing and sticking of eyelashes in children can be constant or transient due to hypothermia and respiratory infections.
- When light pressure is applied to the lacrimal sac, purulent contents are released from the lacrimal point.
- Acute dacryocystitis is rare.
Differential diagnosis of other congenital causes of lacrimation includes punctal atresia and fistula between the lacrimal sac and the skin.
NB: It is important to exclude congenital glaucoma in infants with lacrimation.
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Treatment of nasolacrimal duct obstruction
Massage of the lacrimal sac increases hydrostatic pressure, which can rupture the membrane obstruction. When performing this manipulation, the index finger is placed on the common canal to block reflux through the lacrimal point, then the efforts are directed downwards. It is recommended to perform 10 massage movements 4 times a day, necessarily combining them with eyelid hygiene. Local antibiotics should be used in case of bacterial conjunctivitis, which is quite rare;
Probing of the lacrimal drainage system in a child should be postponed until the child reaches the age of 12 months, since spontaneous restoration of patency occurs in approximately 95% of cases. Probing performed during the first 2 years of life is initially very effective, but then its decrease is observed. The procedure is performed under anesthesia and preferably through the superior lacrimal punctum. It is necessary to manually overcome the obstructing membrane on the Hasner valve. After probing, the lacrimal drainage system is washed with saline solution marked with fluorescein. If fluorescein gets into the nasopharynx, the test is considered positive. Then antibacterial drops are prescribed 4 times a day for 1 week. If there is no improvement after 6 weeks, probing should be repeated. Nasal endoscopic control is especially recommended before repeated manipulation to detect anatomical anomalies and to correctly perform probing.
Results. The first probing cures 90% of sick children, the second - another 6%. The reasons for the ineffectiveness of treatment are, as a rule, anatomical features that complicate probing and subsequent manipulations. If the symptoms of obstruction persist despite two technically satisfactory probings, temporary intubation with plastic tubes or balloon dilation of the nasolacrimal canal can be used. If it is impossible to perform these manipulations, dacryocystorhinostomy can be used in patients aged 3-4 years if the obstruction is distal to the lacrimal sac.