Congenital Nasolacrimal Duct Obstruction

Sasha Mansukhani
Congenital Nasolacrimal Duct Obstruction - Complications
Acute Dacryocystitis, Preseptal and Orbital Cellulitis
Acute dacryocystitis occurs due to stasis of tears in the sac, and is an uncommon complication of CNLDO occurring in around 2-3% cases(9). This infection may spread locally, especially in infants in whom the immune system is not mature. This can cause a preseptal, and can even cause orbital cellultis, although this is a rare complication.
There is a higher incidence of acute dacryocystitis in congenital dacryocoele reported to be around 33%-65%(10,11).

Lacrimal Fistula
Lacrimal fistula is a rare congenital malformation of the lacrimal system, which may occur with or without nasolacrimal duct obstruction(12). Rarely, lacrimal fistula may arise a complication of acute dacryocystitis, wherein the abscess breaks open onto the surface.

Respiratory Distress
Congenital dacryocoele with intranasal cyst, especially if bilateral gives rise to respiratory distress and abnormal feeding, as neonates are obligate nose breathers(13).

Anisometropic Amblyopia
Babies with congenital nasolacrimal duct obstruction have been found to have a greater incidence of anisometropia than the general population. The incidence of anisometropia has been found to be 8.6 to 10 % in such babies, and found to be higher in unilateral than bilateral CNLDO(14,15). Regular refraction to prevent amblyopia is necessary.

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