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Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.

This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care.

Advice

Do not perform nasolacrimal duct probing on children under 12 months old to allow for spontaneous canalisation.

When is the procedure indicated?

Nasolacrimal duct probing may be indicated in children under 12 months old if:

  • discharge is severe and causing skin irritation
  • there is a congenital dilatation of the lacrimal (for example, an amniocele of the lacrimal sac)
  • an abscess, trisomy 21 craniofacial abnormalities and/or congenital dacryocystocele are present
  • other intraocular surgery such as cataract or glaucoma surgery is being considered (not undertaking this procedure increases the risk of endophthalmitis and severe visual loss)
  • there is another indicated intraocular surgery planned and the coexisting nasolacrimal duct obstruction can be addressed at the same time. 

Best care recommendations

More than 90 per cent of cases of nasolacrimal duct obstruction will resolve spontaneously without the need for probing.

Alternative treatment options for nasolacrimal duct obstruction in children under 12 months old include observation, nasolacrimal sac massage, keeping the eye clean, application of a warm compress, and antibiotic eye drops or ointment in cases of infection. 

Evidence

Choosing Wisely UK. Recommendations for clinicians 2016/18. 2019 [Internet]. Choosing Wisely UK; 2016 [cited 2020 Jun 22]. Available from: https://www.choosingwisely.co.uk/i-am-a-clinician/recommendations/#1477561225791-5caf5135-68ab
Örge FH, Boente CS. The lacrimal system. Pediatric Clinics of North America. 2014;61(3):529-39.

Paysse EA, Coats DK.  [Internet]. Congenital nasolacrimal duct obstruction (dacryostenosis) and dacryocystocele.  Waltham (MA): UpToDate; 2019 Nov 11. [cited 2020 Aug 17]. 

Petris C, Liu D. Probing for congenital nasolacrimal duct obstruction. Cochrane Database of Systematic Reviews [Internet]. 2017 Jul [cited 2020 Jun 22];7(CD011109). doi: 10.1002/14651858.CD011109.pub2

The College of Optometrists. Clinical management guideline: Nasolacrimal duct obstruction (nasolacrimal drainage dysfunction). London (UK): The College of Optometrists; 2018 [cited 2020 Jun 22].

The Royal Children’s Hospital Department of Ophthalmology. Primary care liaison nasolacrimal duct obstruction sticky and/or watery eye. Parkville (VIC): The Royal Children’s Hospital Melbourne; 2007 [updated 2011 Aug, cited 2020 Jun 22]. 

The State of Queensland (Children’s Health Queensland). Referral guideline: nasolacrimal duct obstruction (blocked tear duct). Brisbane: The State of Queensland (Children's Health Queensland); 2020 [cited 2020 Jun 22]. 

Page last updated: 23 Dec 2020

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