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CONGENITAL ABNORMALITIES OF THE EYE- NASOLACRIMAL DUCT OBSTRUCTION…
CONGENITAL ABNORMALITIES OF THE EYE- NASOLACRIMAL DUCT OBSTRUCTION
Definition
is the obstruction of nasolacrimal duct and may be either congenital or acquired.
Risk Factors
Children with Down syndrome, craniosynostosis, Goldenhar sequence, clefting syndromes, hemifacial microsomia, or any midline facial anomaly are at an increased risk for congenital nasolacrimal duct obstruction.
Causes
Congenital nasolacrimal duct obstruction, or dacryostenosis, occurs when the lacrimal duct has failed to open at the time of birth, most often due to an imperforate membrane at the valve of Hasne
Diagnostic Studies
Dye disappearance test
The dye disappearance test (DDT) is useful for assessing the presence or absence of adequate lacrimal outflow, especially in unilateral cases. It is more heavily relied upon in children, in whom lacrimal irrigation is impossible without deep sedation
Irrigation test
An irrigation test, a lacrimal irrigation cannula is passed into the punctum and advanced through the canaliculus to the lacrimal fossa. Clear water or saline is then irrigated through the cannula. If fluid passes into the nose without reflux out of the opposite canaliculus, the system is patent. If no fluid passes but it all comes back through either punctum, nasolacrimal duct obstruction is present.
Surgical Management
Primary treatment of nasolacrimal duct obstruction consists of NASOLACRIMAL DUCT PROBING. In this procedure a probe ranging in size from 0.70 to 1.10 mm in diameter is passed through either the upper or lower punctum following dilation of the punctum. The probe is advance along the canaliculus while exerting gentle lateral traction on the lid until it reaches the nasal bone. Then the probe is rotated 90 degrees and gently introduced into the nasolacrimal duct and advanced into the nose.
Signs and Symptoms
The signs of nasolacrimal duct obstruction consist of an increased tear lake, mucous or mucopurulent discharge, and epiphora. The periocular skin is sometimes chapped. The globe is usually white. When pressure is applied over the lacrimal sac there is a reflux of mucoid or mucopurulent material from the punctum.
Medical Management
Medical management of nasolacrimal duct obstruction consists primarily of observation, lacrimal massage, and treatment with topical antibiotics. The efficacy of lacrimal massage in relieving duct obstruction is not well established.
Nursing Management
Nursing Care Plan
Anxiety
Desired Outcomes
Appear relaxed and report anxiety is reduced to a manageable level.
Demonstrate problem-solving skills.
Nursing Interventions
Evaluate anxiety level, degree of pain experienced or suddenness of onset of symptoms, and current knowledge of the condition.
Allow the patient to acknowledge concerns and express feelings.
Pathophysiology
congenital nasolacrimal duct obstruction is most commonly a membranous obstruction at the valve of Hasner at the distal end of the nasolacrimal duct. General stenosis of the duct is the second most common cause of duct obstruction. Congenital proximal lacrimal outflow dysgenesis involves maldevelopment of the punctum and canaliculus. Proximal outflow dysgenesis can occur concurrently with distal obstruction.
Health Education
Massage eye area
Keep eye area clean and dry
