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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As such, the Eyecare Guidelines are not intended for use by the general public and does not replace the advice of a healthcare professional. Members of the public should seek advice directly from their optometrist.
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The information on the Eyecare Guidelines area of the Website provides guidance and related information for the differential diagnosis, possible management by optometrists (treatment and advice),
management category and possible management by ophthalmologists. Users should note that that the Eyecare Guidelines will not be suitable for every situation and is not intended to be a substitute for specialist expertise and clinical judgement.
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