Diagnosis & Treatment

Diagnosis is usually based on clinical criteria. Sometimes ophthalmologists probe and do saline irrigation of the lacrimal drainage system with or without fluorescein dye. Reflux indicates stenosis.

Congenital nasolacrimal duct obstruction

Congenital nasolacrimal duct obstruction often resolves spontaneously by age 6 to 9 mo; before 1 yr, manual compression of the lacrimal sac 4 or 5 times/day may relieve the obstruction. After 1 yr, the nasolacrimal duct may need probing usually under general anesthesia; if obstruction is recurrent, a temporary silastic tube may be inserted.

Acquired nasolacrimal duct obstruction

In acquired nasolacrimal duct obstruction, the underlying disorder is treated when possible. If this treatment is not possible or is ineffective, a passage between the lacrimal sac and the nasal cavity can be created surgically (dacryocystorhinostomy).

Punctal or canalicular stenosis

In cases of punctal or canalicular stenosis, dilation is usually curative. If canalicular stenosis is severe and bothersome, a surgical procedure that places a glass tube (Jones tube) leading from the caruncle into the nasal cavity can be considered.