Congenital glaucoma (buphthalmos and corneal clouding)
Punctal atresia
Congenital
Possible management by Optometrist
Fluorescein disappearance test
A drop of 1% fluorescein should disappear from the tear meniscus in 5-10 minutes (cobalt blue light, room lights off); any longer suggests partial or complete obstruction
Look up nose for presence of fluorescein to confirm patency
Treatment
Do not syringe or probe
Instruct parent in massage
Gentle pressure with finger over common canaliculus, stroking downwards firmly to raise pressure in lacrimal sac and encourage opening of valve
Suggest ten strokes, twice daily
Regular cleaning of discharge from lids
Advice
High rate of spontaneous resolution during the first 12 months of life
Management Category
Alleviation or palliation; normally no referral
Refer for probing if condition fails to resolve by 12 months (>50% resolve within 6 months, 70% by 12 months)
Possible management by Ophthalmologist
None until 12 months of age to allow for spontaneous canalisation
Lacrimal syringing
Probing
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