Management of Paediatric Epiphora

Epiphora in children can have a primary or secondary aetiology. Primary epiphora is caused by an obstruction in the upper (puncta/canaliculi) or lower (nasolacrimal duct) parts of the lacrimal drainage system, with lower blockages being the most common. Congenital nasolacrimal duct obstruction (CNLDO) affects up to 20% of normal neonates, with around 90% of cases resolving spontaneously within the first year of life. Diagnosis is mostly based on digital pressure, dye disappearance testing, and lacrimal probing. Management of CNLDO consists of initial observation with lacrimal sac massage, followed by probing if there is no resolution by the age of 1 year. Probing failures can be treated with silicone intubation, with or without inferior turbinate infracture, or with balloon dacryoplasty. Dacryocystorhinostomy is usually reserved for intubation and balloon dacryoplasty failures. Congenital dacryocystoceles associated with bilateral intranasal cysts can results in neonatal respiratory distress, requiring urgent surgical intervention. Secondary epiphora is usually due to hypersecretion from ocular surface irritation and is often bilateral, with older children describing chronic ocular discomfort or itching.