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Congenital nasolacrimal duct obstruction
What's new
Added 2024 JSLPTD and 2024 CO guidelines for the diagnosis and management of congenital nasolacrimal duct obstruction .
Background
Overview
Definition
CNDO is the failure of one or both nasolacrimal ducts to open properly at birth, leading to tear drainage issues. The obstruction typically occurs at the valve of Hasner, located at the distal end of the nasolacrimal duct.
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Pathophysiology
CNDO results from a persistent membrane at the valve of Hasner, which prevents normal tear drainage from the eye into the nasal cavity. This leads to tear stasis, which can cause secondary infections and inflammation of the lacrimal sac (dacryocystitis).
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Epidemiology
The reported incidence of CNDO ranges from 1.2% to 30%, depending on the diagnostic criteria used. It is estimated that 70% of all newborns are born with CNDO, but only 6-20% of them develop symptoms.
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Risk factors
Risk factors include a family history of the condition, craniofacial anomalies, and certain genetic syndromes. Prematurity, Down syndrome, and Caucasian race have also been associated with increased risk of CNDO.
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Disease course
The clinical course of CNDO often begins with symptoms such as excessive tearing (epiphora), recurrent eye discharge, and crusting of the eyelashes, typically presenting within the first weeks of life.
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Prognosis and risk of recurrence
Most cases resolve spontaneously within the first year of life. Persistent cases may require intervention, such as lacrimal sac massage, probing, or surgical procedures.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of congenital nasolacrimal duct obstruction are prepared by our editorial team based on guidelines from the College of Optometrists (CO 2024) and the Japanese Society of Lacrimal Passage and Tear Dynamics (JSLPTD 2024).
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