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Congenital nasolacrimal duct obstruction leading to epiphora is a common condition that may be seen in up to 20% of infants. The management ranges from conservative therapy to the Crigler technique fr correction. Moreover, the technique of applying pressure on the lacrimal sac is not well known among clinical providers and warrants review. In this activity, the exact technique is described and presented with illustrations and a video. The aim is to teach the method to physicians, nurses, and technicians so that it may be taught properly to the parents of the child and improve clinical outcomes. Objectives: Explain the etiology of congenital nasolacrimal duct obstruction. Review the different outcomes depending upon the techniques used to treat congenital nasolacrimal duct obstruction. Outline the correct way to perform the Crigler technique for children with congenital nasolacrimal duct obstruction. Describe the importance of collaboration of pediatricians, primary care physicians, ophthalmologists, and nurses in order to learn the correct technique to treat congenital nasolacrimal duct obstruction. Access free multiple choice questions on this topic.

Congenital nasolacrimal duct obstruction (CNLDO) is defined as the failure of drainage of tears down the nasolacrimal system in the neonatal age group. It results in tearing, which is termed "epiphora." The prevalence of CNLDO is between 5% and 20%.[1][2] A comprehensive study of 4792 infants in Great Britain showed that the prevalence of epiphora in the first year of life was 20%, with 95% of these showing symptoms at one month of age.[1] There is a higher prevalence of CNLDO in premature infants.[3] CNLDO presents bilaterally in 14% to 34% of cases.[4] It has also been shown that anisometropic amblyopia may occur in 10% to 12% of children with CLNDO, so a proper ophthalmic eye examination and cycloplegic refraction are performed in all cases with a careful subsequent follow-up for three to four years.[5][6] Of interest is the finding of Cassidy in 1952, who noted that there was obstruction of the nasolacrimal duct in 13 of 15 stillborn infants. His postulation that patency of the nasolacrimal duct occurs within the first few days to weeks after birth is a reasonable one.[7] Children most often present within a few months of birth with epiphora and sometimes mucoid discharge from one or both sides. However, even with symptoms present since birth, patients may present when several years old. Other causes of epiphora in children like epiblepharon, congenital glaucoma, foreign body, corneal infections, and corneal dystrophies need to be excluded. Wheres the Jones 1 test where insertion of fluorescein dye into the eye is followed by the presence of dye in the nose after 5 minutes may be used, it is rarely used now since the clinical history and observation of the tearing, and mucoid discharge generally confirms the diagnosis. Similarly, the dye disappearance test over 5 minutes may also be used, but there may be significant false positive and negative results in infants.

We are presenting details of this technique so that not only physicians but other clinic staff like technicians, physician assistants, and nurses may be familiar with it and can show the parents how to perform it. We ensure that everyone in our pediatric clinic is familiar with the technique, and each person is able to teach it to the parents. [Level 3]