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Clinical Review

Fortnightly review: Managing congenital lacrimal obstruction in general practice

BMJ 1997; 315 doi: (Published 02 August 1997) Cite this as: BMJ 1997;315:293
  1. James D H Young, consultant ophthalmologista,
  2. Caroline J MacEwen, consultant ophthalmologista
  1. a Department of Ophthalmology, Ninewells Hospital and Medical School, Dundee DD1 9SY
  1. Correspondence to: Dr Young


    Every year thousands of infants are taken to their general practitioner because they have developed a persistently watering or sticky eye. Congenital nasolacrimal duct obstruction is by far the most common cause of these symptoms, and an understanding of the natural course of this condition is the key to planning the management of affected infants. While most children can be managed without referral to a specialist ophthalmic service, it is important to recognise that watering and discharge can occasionally be among the presenting features of rarer, more serious conditions.


    This review is based on the information acquired in the course of our longstanding clinical and research interest in managing congenital lacrimal obstruction. Additional literature was searched for manually in journals and as a computer search of Medline to January 1977 (Ovid Technologies) with the heading “lacrimal duct obstruction” and the textwords “congenital nasolacrimal duct obstruction” and “epiphora.”

    Natural course and the options for management

    Natural course

    The lacrimal passages develop in a column of surface ectoderm buried in the naso-optic groove. Canalisation to form the nasolacrimal duct is not complete at the lower end until birth, and a membranous obstruction may persist in up to 70% of neonates (fig 1).1 If this impatency persists the parents may observe watering and discharge from the eye; symptoms reported in 6-20% of all infants.2 3 Other causes of lacrimal obstruction occur less commonly and do not alter the early management within general practice.

    Fig 1

    The lacrimal drainage system. Congenital nasolacrimal duct obstruction is usually caused by a persistent membranous obstruction at the lower end of the nasolacrimal duct

    Summary points

    Twenty per cent of infants develop the symptoms of congenital lacrimal obstruction during their first month of life

    Spontaneous resolution is the commonest outcome, without treatment only 0.7% of infants will still be affected by their first birthday

    After considering the differential …

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