Lacrimal duct obstruction with conjunctivitis not improving after 2 weeks of topical antibiotics; next step?

Lacrimal duct obstruction with conjunctivitis not improving after 2 weeks of topical antibiotics; next step?

• A. Refer to ophthalmologist.
• B. Massage more frequently.
• C. Prescribe an oral antibiotic.
• D. Recommend hot compresses.

Answer: (A)

A lingering tearing with conjunctivitis that doesn’t improve after a couple of weeks of topical antibiotics suggests a blockage in the tear drainage system rather than only an infection. In infants, congenital nasolacrimal duct obstruction is common and often shows up as persistent discharge and tearing; initial care can include lacrimal sac massage and hot compresses, but these measures don’t fix the underlying blockage. When there’s no improvement after a reasonable trial of topical therapy, the appropriate step is to have an ophthalmologist evaluate for possible nasolacrimal duct obstruction and discuss corrective options. An ophthalmologist may perform probing or other procedures to relieve the obstruction, sometimes under anesthesia, depending on the finding.

A lingering tearing with conjunctivitis that doesn’t improve after a couple of weeks of topical antibiotics suggests a blockage in the tear drainage system rather than only an infection. In infants, congenital nasolacrimal duct obstruction is common and often shows up as persistent discharge and tearing; initial care can include lacrimal sac massage and hot compresses, but these measures don’t fix the underlying blockage. When there’s no improvement after a reasonable trial of topical therapy, the appropriate step is to have an ophthalmologist evaluate for possible nasolacrimal duct obstruction and discuss corrective options. An ophthalmologist may perform probing or other procedures to relieve the obstruction, sometimes under anesthesia, depending on the finding.