Related Experiment Video
Updated: May 9, 2026
Establishment of a Severe Dry Eye Model Using Complete Dacryoadenectomy in Rabbits
Published on: January 8, 2020
Visual diagnosis: 2-month-old girl with left eye swelling, profuse tearing
Meghan Mary O'Connor1, Marta Ania King
1Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Insights
Nasolacrimal duct (NLD) obstruction causes persistent tearing in infants. Most cases resolve with massage, but dacryocystoceles and acute dacryocystitis require urgent ophthalmologist referral due to infection risks.
Area of Science:
- Ophthalmology
- Pediatrics
Background:
- Nasolacrimal duct (NLD) obstruction is the most frequent cause of persistent tearing in infants under one year.
- Differential diagnoses include congenital eyelid abnormalities, chemical irritation, trauma, foreign bodies, glaucoma, and conjunctivitis.
Observation:
- Dacryocystoceles manifest with bluish swelling over the nasolacrimal sac, in addition to NLD obstruction signs.
- Acute dacryocystitis involves erythema, swelling, warmth, and tenderness of the lacrimal sac.
Findings:
- Conservative management with observation and nasolacrimal massage resolves NLD obstruction in approximately 90% by 6 months and over 99% by 12 months.
- Urgent ophthalmology referral is critical for dacryocystoceles due to high complication risks, particularly infection.
- Prompt identification and treatment of acute dacryocystitis are essential to prevent severe complications like cellulitis, meningitis, and sepsis.
Implications:
- Delayed ophthalmology referral for persistent NLD obstruction is appropriate until 6-9 months of age.
- Early intervention for dacryocystoceles and acute dacryocystitis is crucial for preventing sight-threatening and life-threatening complications.
- Understanding these distinctions guides appropriate clinical management and referral pathways for pediatric epiphora.
Abstract:
Nasolacrimal duct (NLD) obstruction is the most common cause of persistent tearing in a child younger than 1 year. Other possible causes include congenital eyelid abnormalities, chemical irritation, trauma, occult foreign body, congenital or early-onset glaucoma, and conjunctivitis. • In addition to NLD obstruction signs, dacryocystoceles also present with swelling over the nasolacrimal sac. The swelling often has a bluish discoloration. • Management of NLD obstruction requires a conservative approach with observation and nasolacrimal massage because spontaneous resolution occurs in approximately 90% by age 6 months and in more than 99% by age 12 months. Referral to an ophthalmologist for children with persistent symptoms should be deferred until at least ages 6 to 9 months. • Because of the high risk of complications with dacryocystoceles, especially infection, these patients require urgent ophthalmology referral. • Acute dacryocystitis presents with erythema, swelling, warmth, and tenderness of the lacrimal sac. The infection must be identified and treated early to prevent complications, such as periorbital and orbital cellulitis, meningitis, brain abscess, and sepsis.
