Blocked tear duct

Disclaimer

These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Refer to the Emergency Department immediately if patient is a neonate with:

  • visible swelling over the lacrimal sac, bluish discolouration of overlying skin, or a pus filled abscess
  • cellulitis and not responding to treatment with antibiotics or with signs of sepsis.
 

Introduction

Nasolacrimal duct obstruction is a common condition in infants causing tearing and a sticky yellowish – green discharge in one or both eyes. This discharge is generally not infective but consists of mucous naturally produced by the lacrimal sac. The appearance differs from conjunctivitis in that the child will not have any discomfort and the conjunctiva remains white. Gentle massage of the lacrimal sac may cause expression of mucous. 

90% of nasolacrimal duct obstructions will spontaneously resolve by 12 months of age. Due to this, referrals should wait until the child is 1 year of age.

Pre-referral investigations

  • No pre-referral guidelines required.

Pre-referral management

  • Reassure the family that in most cases the duct will open spontaneously and the discharge is usually mucous from the duct and not necessarily a sign of conjunctivitis. 
  • Educate the family on how to massage the nasolacrimal sac, keeping the eye clean and signs of infection. Provide Blocked tear duct - PCH Health Fact sheet.
  • Treat infection as required.
  • A red painful lump at the side of the nose may indicate dacryocystitis and will require oral antibiotics and urgent referral to PCH Ophthalmology Department.

When to refer

Refer to the Ophthalmology Department when:

  • suspected dacryocystitis – urgent referral 
  • if symptoms persist over the age of 12 months
  • refer infants under 12 months with severe discharge causing skin irritation.
  • swelling over lacrimal sac
  • light sensitivity, corneal opacity or enlargement of the eye.

How to refer

  • Routine non-urgent referrals from a GP or a Consultant should go to the Central Referral Service
  • Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals go to the PCH Referral Office
  • Urgent referrals (less than seven days) go to the PCH Referral Office. Please call Perth Children’s Hospital Switch on 6456 2222 to discuss referral with the relevant speciality. 

Essential information to include in your referral

  • Patient demographics including parent contact details.
  • History of condition (amount of discharge, any history of infections, any management).

Useful resources

References

  1. Karti O, Karahan E, Acan D, Kusbeci T. The natural process of congenital nasolacrimal duct obstruction and effect of lacrimal sac massage. The International Journal of Clinical Ophthalmology and Visual Sciences. 2016;36(6):845-9.
  2. Örge FH, Boente CS. The Lacrimal System. The Pediatric clinics of North America. 2014;61(3):529-39.
  3. Ophtalmology Department Women's and Children's Hospital. Blocked Tear Ducts Information for Referrers. In: Women's and Children's Hospital, editor. South Australia: Women's and Children's Hospital.
  4. Perth Children's Hospital. Blocked Tear Duct (Nasolacrimal Duct Obstruction). In: Hospital PCs, editor.: Child and Adolescent Service; 2020.
 

Reviewer/Team: Dr David Greer and Professor Geoff Lam - Ophthalmology Department, PCH Last reviewed: June 2021


Review date: June 2024
Endorsed by:

CPAC Date:  June 2021


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