Congenital Nasolacrimal Duct Obstruction
In babies, the initial treatment involves massaging the area around the affected lacrimal sac to force the tears down the duct, and to push open the membrane causing the obstruction. This works in about 90% of cases. If the symptoms do not resolve by 9 months of age, a small office-based procedure is necessary to open the membrane in the nose. After 1 year of age, the membrane can only be opened in the operating room using an endoscope under general anesthesia. The advantage of using an endoscope to directly visualize Hasner’s valve is the high success rate of the procedure and the decreased risk of complications. This outpatient procedure takes less than 15 min.
In the rare instance where the bony nasolacrimal duct is absent (congenital malformation), a bypass procedure that directly connects the lacrimal sac with the nose can be done endoscopically (eDCR) around 4 years of age. This reestablishes the missing anatomy and is usually permanent.