Epiphora indicating blocked nasolacrimal duct in babies- These children have a history of watery eye since birth with some discharge.
The discharge only responds to antibiotics whilst it is being administered but the infection will return immediately when treatment ceases. Repeated courses of antibiotics is not recommended and parents should be educated to an understanding that in 90% of cases this problem will resolve spontaneously by 18 months old.
Massage over the lacrimal sac is believed to help but there is no published evidence. Cleaning the eye regularly with salty water is recommended and pushing on the sac to release the pus will decrease the frequency washing is required. A small amount of Vaseline applied to the lower eyelid can waterproof the skin to prevent lower eyelid soreness.
Referral is recommended at 15 months old as this gives time to put the child on the waiting list and perform the operation at the optimum time of 18 months.
The treatment window is narrow and children left until after 2 years old have a decreased prognosis with a simple syringing and probing.
Late referrals require nasolacrimal intubation, a longer GA and a second GA sometimes to remove the tube. They are also more likely to require a 3rd procedure.