Case Studies in Ophthalmology
Cases for the Ophthalmology Clerkship
Note to Medical Students on the Ophthalmology Rotation at the University of Iowa:
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Case #50 Nasolacrimal Duct Obstruction
History
Case 1: At about two to four weeks of age, the patient developed “watery” eyes with a tendency for tears to spill over his lower lids unassociated with crying.
Case #1
Case 2: This infant was born with the bluish swelling between the base of the nose and the inner canthus.
Case #2
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Question #1
Discuss the anatomy and physiology of the lacrimal drainage system depicted in the following slide.
Photo #3
Question #2
Discuss the causes and natural history of congenital nasolacrimal duct obstruction.
Question #3
Discuss the treatment options of nasolacrimal duct obstruction.
Question #4
What are the potential complications of no treatment?
Question #5
What is the lesion in the second clinical picture (Photo 2) and how does it relate to nasolacrimal duct obstruction?
Question #6
Discuss other causes of tearing in infants and children such as in Photo 1.
References
Kushner BJ: Congenital nasolacrimal system obstruction. Arch Ophthalmol 1982: 100:597-600.
Harris GJ, DiClementi D: Congenital dacryocystocele. Arch Ophthalmol 1982; 100:1763-1765.
Duane T: Biomedical Foundations of Ophthalmology. Harper & Row, pp14-20.
Petersen RA, Robb RM: The Natural course of congenital obstruction of the nasolacrimal duct. J Ped Ophthal 1978; 15:246-250.