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Congenital nasolacrimal duct obstruction

The following information provides a guide for GPs on how to manage or make a referral for presentation of Congenital nasolacrimal duct obstruction – delayed tear duct opening from birth.

  • Low pathology

    • Age less than 12 months 
    • Watery eye
    • Occasional yellowish/greenish discharge
    • No worrying signs (enlarged or cloudy cornea)

     

    Do not refer (See GP management & self care below)

  • Non-resolving

    Age over 12 months

     

    Non-urgent e-referral to Eye Clinic

  • Potentially serious Pathology

    • Cornea appears cloudy/grey
    • One or both eyes/corneas look bigger than usual
    • Child unusually sensitive to light (infantile glaucoma)
    • Preseptal/orbital cellulitis
    • Dacryocystitis

     

    Urgent referral to Acute Eye Clinic

GP Management

Re-assure family

• Common condition (1 in 5)

• Spontaneous resolution 80-96% before first birthday

Self-care & advice

• Wipe lids to dry

• Skin ointment (Vaseline) to protect skin 

• DO NOT USE herbal teabags, breast milk applied to eyes or similar

• If episode of yellow/green discharge, buy chloramphenicol eye drops from chemist and use for 5-7 days

 

Referral information

• If possible, attach photo of eye to e-referral

Always include:

• Child’s date of birth

• Address

• Child’s social worker details (including Borough), if any

• Parent/carer contact phone number and email 

 

Further assistance

This pathway has been produced by Moorfields Eye Hospital NHS Foundation Trust to help clinicians manage the healthcare of children and young people. However, if you need to contact a paediatric clinician, please see below for contact details:

Moorfields Eye Hospital:

Paediatric helpline: 0207 2533411 extn 4569, Mon- Fri 10:00am-13:00pm then 14:00pm-16:00pm 

video transcript
To clean the eyelids the first step is to do a warm compress which softens the debris on the eyelids making it easy to clean off.
Place a clean face cloth under a hot tap, nice and hot but not hot enough to burn or be uncomfortable. Wring it out and hold the hot compress on top of the closed eyes for one or two minutes.
If the cloth becomes cool, warm under the tap again, wring and replace it on the closed lids.
Next we perform the cleaning for older children we use a moistened cotton pad. This can be moistened in warm tap water or by using a weak solution of baby shampoo or bicarbonate of soda.
Squeeze out any excess moisture.
First you clean the back edge of the eyelid. Pull down the lower lid and run the bud firmly but gently along the thin line of skin behind the lashes four or five times.
 Do the same for the top lid putting it up and away from the eye. Then we clean the lashes. For the top lid, close the eyes firmly and scrub vigorously at the base of the lashes doing a small part of the lid at a time and moving gradually along the width of the lid to do all the lashes.
In the same movement to use for brushing your teeth. Then open the eye, look up and repeat with the bottom lid lashes, again moving gradually along the lid to ensure all the lashes are clean.
Ideally older children should be taught to do this themselves.
For younger children we start again with a warm compress.  Then use a face cloth to clean the lid edges moistened in warm tap water or with a weak solution of baby shampoo or bicarbonate of soda.
After moistening wring out the cloth wrapped the cloth tightly around the index finger so it covers the length of the finger holding the rest of the cloth in the hand.
With the child's eyes gently closed lay the finger with the length of the cloth along the lashes apply gentle pressure towards the eye and wipe up in a sweeping motion two to three times to clean the upper lid.
The gentle pressure towards the eyes will allow the eyelids to turn out a little so that the back edge of the eyelids are cleaned. Then wipe down two or three times in the same way to clean the lower lid.
To clean the base of the lashes; with your child's eyes tightly closed use the length of the the finger covered by the cloth to rub quite vigorously along where the lashes come out at the skin moving along the eyelids so that all areas are cleaned.

Last updated: April 2021