Congenital nasolacrimal duct obstruction

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Target exams

Red flags

• An infant with epiphora plus photophobia, blepharospasm, a large or cloudy cornea, or a watering eye that is also light-averse — congenital glaucoma until proven otherwise; refer urgently to ophthalmology, because each week of delay costs vision
• A tender, red, swollen mass at the inner canthus with systemic upset — acute dacryocystitis, which can progress to preseptal or orbital cellulitis and septicaemia; needs systemic antibiotics and urgent ophthalmology
• A newborn with a blue-grey cystic swelling at the inner canthus and respiratory distress or feeding difficulty — a congenital dacryocystocele with intranasal extension compromising the neonatal airway; an airway and ENT and ophthalmology emergency
• A sticky eye that is also red, with photophobia or a hypopyon — conjunctivitis, keratitis, ophthalmia neonatorum or trauma, not simple duct obstruction; re-evaluate and refer
• Unilateral or disproportionate epiphora with an abnormal red reflex, a white pupil, or a structural eye abnormality — congenital cataract, retinoblastoma or a corneal opacity; urgent ophthalmology

Life stages

Care settings

Clinical exam formats

Board mappings

• General Paediatrics and Ophthalmology: congenital nasolacrimal duct obstruction as the commonest cause of epiphora in a white quiet infant eye, recognition, Crigler massage and reassurance
• Neonatology and Ophthalmology: distinguishing a blocked tear duct from ophthalmia neonatorum, congenital glaucoma and dacryocystitis
• Renewed curriculum — Ophthalmology: the probing-timing evidence, natural history of spontaneous resolution, and indications for intubation and balloon dacryoplasty
• Development and disability: complex obstruction in Down syndrome and craniofacial syndromes
• General Paediatrics: diagnosis and conservative management of CNLDO, the safety-net for congenital glaucoma and dacryocystitis, and when to refer
• Communication: reassuring families about the self-limiting course and teaching Crigler massage technique
• Long Case / Structured discussion: an infant with persistent tearing and discharge — diagnosis, the probing-timing controversy, and the management sequence
• Communication station: explaining massage technique, expected natural resolution, and the rationale for timing of probing
• Level 2 / 3 — Ophthalmology: epiphora in infancy, CNLDO, conservative management and referral thresholds
• Patient safety: recognising congenital glaucoma and acute dacryocystitis as the must-not-miss mimics
• Foundation of Practice (FOP): the sticky eye in infancy — CNLDO versus conjunctivitis, ophthalmia neonatorum and congenital glaucoma
• Applied Knowledge in Practice (AKP): the stepwise management of CNLDO, the natural history and the timing of probing
• History-taking and management: the infant with a sticky watering eye, and reassuring the family
• Communication: teaching Crigler massage and explaining the self-limiting course and follow-up plan
• General Pediatrics Content Outline — congenital nasolacrimal duct obstruction: recognition, massage, natural history and referral
• Neonatology and Ophthalmology: distinguishing CNLDO from ophthalmia neonatorum and congenital glaucoma
• Patient Care: diagnosis and stepwise management of CNLDO across infancy, with accurate safety-netting for sight-threatening mimics
• Systems-Based Practice: timely and equitable access to ophthalmology for probing and surgical intervention
• Medical Knowledge: failure of canalisation at the valve of Hasner, natural history and the probing-timing evidence
• Medical Expert: CNLDO diagnosis, Crigler massage, the probing-timing decision and surgical options, including dacryocystocele and dacryocystitis
• Health Advocate and Collaborator: equitable access to paediatric ophthalmology for remote and Indigenous families
• Communicator: explaining the self-limiting course, teaching massage and providing a clear safety-net