This guideline last updated 06/05/2022 17:45:35

Differential diagnosis

• Congenital glaucoma (buphthalmos and corneal clouding)
• Punctal atresia
• Congenital

Possible management by Optometrist

• Fluorescein disappearance test
  • A drop of 1% fluorescein should disappear from the tear meniscus in 5-10 minutes (cobalt blue light, room lights off); any longer suggests partial or complete obstruction
  • Look up nose for presence of fluorescein to confirm patency

Treatment

• Do not syringe or probe
• Instruct parent in massage
• Gentle pressure with finger over common canaliculus, stroking downwards firmly to raise pressure in lacrimal sac and encourage opening of valve
• Suggest ten strokes, twice daily
• Regular cleaning of discharge from lids

Advice

• High rate of spontaneous resolution during the first 12 months of life

Management Category

• Alleviation or palliation; normally no referral
• Refer for probing if condition fails to resolve by 12 months (>50% resolve within 6 months, 70% by 12 months)

Possible management by Ophthalmologist

• None until 12 months of age to allow for spontaneous canalisation
• Lacrimal syringing
• Probing