The following pre-referral guideline covers nasolacrimal duct obstruction (sticky/watery eye). Please see other ophthalmology guidelines as needed including Abnormal pupil reaction and size, Abnormal red reflex/white pupil or Decreased visual acuity.

Seeresources for referral form, parent information and more.

Initial findings and when to refer

• Birth - 2 weeks - acutely sticky eye with severe amounts of discharge:
  • IMMEDIATE REFERRAL - to ED
    
    
• Neonates - with visible dilation of lacrimal sac and bluish discoloration of overlying skin:
  • IMMEDIATE REFERRAL - for sepsis concerns - to ED
    
    
• Ages 2 - 12 months with chronic tearing and discharge:
  • Referrals for probing are not accepted until patients are over 12 months of age unless discharge is severe and causing skin irritation. Treat medically (as outlined below).
    
    
• 12 months onwards - patients with increased tearing that persists past 12 months of age:
  • Treat medically (as outlined below). 
  • Refer only if symptoms persist for more than 3 months.
  • Refer non-urgently for nasolacrimal duct probing.

Recommended medical treatment - chronic tearing

1. Massage the nasolacrimal sac.
2. Keep the eye clean - wash with salt water as needed.
3. Apply warm compresses (clean, warm washcloth held against closed eyelid for 2-5 minutes, 2-5 times per day.
4. Apply chloramphenicol eye drops or ointment until tears become clear, as per  Paediatric Pharmacopoeia

Contact information

RCH Switchboardtelephone (03) 9345 5522

For clinical advice ask for:

• Ophthalmology registrar or consultant on-call
• Department of Ophthalmology - clinical advice (or direct dial 03 9345 5630)
• Emergency Department - for clinical advice after hours

• For urgent appointments also call 03 9345 6180

Admission enquiries ask for:

• General admission enquiries (or direct dial 03 9345 6172)
• ED admission enquiries: (or direct dial 03 9345 6477)

Resources

• RCH OPD referral (word)

  • Generic parent handout (about RCH pre-referral guidelines)
• Kids Health Info - parent information website
• Kids Connect (Primary Care Liaison) www.rch.org.au/kidsconnect
  OPD resources for GPs page contains all referral forms, clinic information, referral process information, other pre-referral guidelines, MBS Enhanced Primary Care Items and parent information.

References

Paediatric Handbook (2009). Eye Conditions, Chapter 23 (pp357-368). James Elder and Peter Barnett. 8th Ed, Blackwell Publishing by the Staff of the Royal Children's Hospital, Melbourne. Australia.

Feedback

Please give feedback on this guideline - kids.connect@rch.org.au / telephone: (03) 9345 4645 / fax (03) 9345 4650

Last updated

Last update: August 2011

Guideline developed by the RCH Department of Ophthalmology in consultation with a GP Review Group. Many thanks to the GPs involved in the review.  First published Dec 2007. Reviewed August 2009. Please read  Copyright and Disclaimer.