A classic triad of epiphora, photophobia and blepharospasm may be the only clue to this rare, sight-threatening condition.
A six-month-old boy with a complex craniofacial disorder presented to the ophthalmology clinic with a chronic watery eye (Figure 1). He had a small, intermittent, right-sided divergent squint related to his craniofacial disorder, but his visual ability was normal for his age. On examination, his eyes were not enlarged and both corneas were clear.
The patient’s lower tear meniscus was visibly enlarged, suggesting a diagnosis of congenital nasolacrimal duct obstruction (NLDO). The application of pressure over his right nasolacrimal sac resulted in the expression of clear fluid from the puncta, which supported the diagnosis.