A 6-month-old infant has persistent watering from the left eye with mucoid discharge since birth. The left lacrimal sac swells with pressure and mucus can be regurgitated. Digital pressure over the sac relieves the swelling. The most likely cause and initial management are:
- A Congenital dacryocystitis from failure of canaliculus formation; dacryocystorhinostomy (DCR)
- B Nasolacrimal duct obstruction from failure of Hasner's valve to open; massage and topical antibiotics, with probing at 9-12 months if unresolved ✓
- C Acute dacryocystitis; systemic antibiotics and immediate DCR
- D Punctal atresia; surgical punctal dilation
Correct answer: B. Nasolacrimal duct obstruction from failure of Hasner's valve to open; massage and topical antibiotics, with probing at 9-12 months if unresolved
Explanation
Congenital nasolacrimal duct obstruction (CNLDO) in infants results from failure of the membranous valve of Hasner at the lower end of the nasolacrimal duct to open at or after birth. The classic presentation is epiphora and mucopurulent discharge with a palpable, regurgitatable lacrimal sac mucocoele. Up to 90% resolve spontaneously within the first year with Crigler lacrimal sac massage and topical antibiotics. Probing under general anaesthesia is recommended if obstruction persists beyond 12 months.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.