What are the physical exam findings of neonatal nasolacrimal duct obstruction?

From the Research

On physical examination of neonatal nasolacrimal duct obstruction, look for tearing (epiphora), crusting of the eyelashes, and mucoid discharge at the medial canthus of the affected eye, as these are the most common physical exam findings associated with this condition 1.

Key Physical Exam Findings

• Tearing (epiphora)
• Crusting of the eyelashes
• Mucoid discharge at the medial canthus of the affected eye
• Reflux of mucopurulent material when applying gentle pressure over the lacrimal sac area
• Normal conjunctiva without significant injection or inflammation, which helps differentiate it from conjunctivitis
• Erythema and swelling over the lacrimal sac region may indicate dacryocystitis, a complication of the obstruction

Diagnostic Tests

• The fluorescein dye disappearance test can be performed by placing a drop of fluorescein in the conjunctival fornix and observing for clearance; delayed clearance suggests obstruction 2

Prevalence and Resolution

• The condition is common, affecting up to 20% of newborns, and is usually unilateral but can be bilateral 3
• Most cases resolve spontaneously by 12 months of age with conservative management including gentle massage of the lacrimal sac and maintaining good eyelid hygiene 4

Management

• Conservative therapy, including observation, lacrimal sac massage, and antibiotics, is often the best option in infants aged <1 year 1
• In children aged >1 year, nasolacrimal probing successfully addresses most obstructions, but the most favorable timing for probing remains controversial 2