Lacrimal Obstruction

The watering of one or both eyes soon after birth is a common problem. The obstruction is normally at the lower end of the nasolacrimal duct, where a congenital plug of tissue remains. Infection causing purulent discharge can be treated effectively by the use of antibiotic drops. Although these should clear the unpleasant discharge, the eye continues to water as long as the tear duct is blocked. The mother can be shown how to massage the tear sac. This manoeuvre causes mucopurulent material to be expressed from the lower punctum when there is a blockage and can be used as a diagnostic test. If carried out regularly, this helps to relieve the obstruction. In most cases, spontaneous relief of the obstruction occurs, but if this does not occur after about six to nine months, probing and syringing of the lacrimal passageway under general anaesthesia is an effective procedure, which can be done as a day case. It is important to remember that a watering eye can be caused by excessive production of tears as well as inadequate drainage, and in a child, a corneal foreign body or even congenital glaucoma might be mistaken for lacrimal obstruction by the unwary.

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