Congenital nasolacrimal duct obstruction — formative SAQs

SAQ 1 (10)

A ten-week-old is brought in because the right eye has been watering for a month and is sticky in the morning, the lashes glued by a yellow crust. The watering is worse during a cold and quieter between episodes. On examination the eye is white and quiet, there is reflux of mucopurulent material on firm pressure over the lacrimal sac, the red reflex is normal and the cornea is clear and of normal diameter. The infant is otherwise well and growing. ^[4]

a) State the most likely diagnosis and the single most important mimic to exclude, naming the bedside features that separate them. (3 marks) ^[4]

b) Outline the first-line management, naming the specific technique and its frequency, and explain why topical antibiotics are not routine. (3 marks) ^[4]

c) Explain the probing-timing controversy, drawing on the natural history and the procedural-success data, and state when you would offer probing. (2 marks) ^{[2] [5]}

d) Describe two safety-net features that would bring the family back urgently, and explain why each is not a simple duct obstruction. (2 marks) ^[4]