Pediatric lacrimal disorders

• Nasolacrimal duct obstruction (NLDO) is one of the most common abnormalities in pediatric ophthalmology. • NLD often resolves spontaneously. • The symptom that is most useful in distinguishing NLDO from other causes of epiphora is the lack of photophobia. • In-office probing of younger patients with NLDO and operating room probing of older patients are acceptable treatments. • Recognition of different types of NLDO is useful in guiding management: - Most NLDO is due to membranous obstruction of the distal NLD and is relieved with simple NLD probing. - Some children with NLDO have diffuse stenosis of the distal NLD, which may require more than simple probing to treat effectively (either balloon catheter dilation or stents). - A small number of children with NLDO (particularly infants with mucoceles) have cysts or other abnormalities of the distal NLDO. • Nasal endoscopy is a useful adjunct to treatment of children with complicated NLDO.