Referral guideline – Nasolacrimal duct obstruction (blocked tear duct)

Introduction

Watery, sticky eyes in young children are often caused by nasolacrimal duct obstruction (NLDO). It is a common condition with over 5% of infants having symptoms affecting one or both eyes. By 12 months of age, 90% of these cases have spontaneously resolved.

Symptoms of NLDO include tearing, a sticky discharge, and mild swelling or redness of the lower lid. Symptoms may increase in the presence of an upper respiratory tract infection. Occasionally more severe swelling and redness can occur, representing infection of the lacrimal sac (dacrocystitis).

Examination of the eye is essential to distinguish NLDO from rare, serious eye disorders such as congenital glaucoma.

GP management

  • Nasolacrimal sac massage and keep the eye clean as needed with saline
  • Warm washcloth against the closed eyelid for 2-5 minutes, 2-5 times per day
  • Short course of chloramphenicol eye drops if infection develops (2nd hourly for 3 days)
  • Take advantage of the opportunity to examine the child’s eyes for ocular motility, the presence of a red reflex, pupillary reactions and sizes

When to refer

  • If any of the following red flags are present, IMMEDIATE REFERRAL is indicated. Please discuss with the on call ophthalmology registrar – photophobia , increase in size or difference in size of the corneas or a cloudy or hazy cornea.
  • If acute dacrocystitis and orbital cellulitis is suspected, refer to the emergency department.
  • Neonates with an acutely sticky eye and severe amounts of discharge should be referred to the emergency department to exclude ophthalmia neonatorum. IMMEDIATE REFERRAL is indicated.
  • Persistence of nasolacrimal duct obstruction with chronic tearing and discharge beyond 12 months of age – non-urgent referral.
  • Please note: referrals for chronic tearing and mild discharge in infants aged 2-10 months are not accepted.

Essential referral info

  • Presenting complaint and reason for referral
  • Detailed history of symptoms and treatment to date
  • Presence of any red flags as above
  • Patient details including Medicare number
  • Parent/Carer’s name and contact details

From 1 May 2019 referral criteria will apply at CHQ. This condition has minimum demographic and essential clinical referral information that is required to be included prior to submission of the referral. Visit the CPC website for the required condition. If you are unable to provide the required “essential information” please state the reason when you submit the referral.

Helpful referral info

  • Ocular history, including other eye problems, injuries, diseases, surgery, treatments including glasses and/ or amblyopia therapy
  • Other past medical and surgical history
  • Antenatal and perinatal history that may be relevant – prematurity, birth weight, birth trauma, alcohol/drug use in pregnancy
  • Family history – of eye conditions or genetic conditions
  • Current medications and allergies
  • Examination findings – including any dysmorphic features, full ocular examination
  • Is the patient of Aboriginal or Torres Strait Islander descent?

Parent service

Otolaryngology Head and Neck Surgery

Contact details

Hospital Switchboard
(Ask for Ophthalmology On-call Registrar)
t: 07 3068 1111

Resources

How to apply eye ointment
How to apply eye drops
List of CHQ aligned optometrists
Emergency Eye Manual
Paediatric Optometry Alignment Program