Rosh Pediatrics Practice Exam

In a 2-month-old with excessive tearing and debris in the right eye, what is the initial management of his likely condition?

1. Gentle massage of nasolacrimal duct

2. Lacrimal duct probing

3. Referral to ophthalmology

4. Topical antibiotics

The correct answer is: Gentle massage of nasolacrimal duct

The situation described involves a 2-month-old with signs of excessive tearing and debris in one eye, which is characteristic of nasolacrimal duct obstruction. This is a common condition in infants, and the initial management involves conservative measures to encourage the duct to open on its own. Gentle nasolacrimal duct massage is recommended as the first line of treatment. This technique involves applying pressure at the inner corner of the eye, which can help facilitate drainage through the nasolacrimal duct. This non-invasive approach is often effective, especially in younger infants, as many cases of congenital nasolacrimal duct obstruction resolve spontaneously within the first year of life. In contrast, more invasive options like lacrimal duct probing may be considered if the obstruction persists for an extended period, but they are not the initial steps of management. Similarly, a referral to ophthalmology is usually unnecessary unless the condition doesn’t resolve or there are other concerning symptoms that suggest a more serious issue. Topical antibiotics would only be relevant if there were signs of infection, which is not indicated solely by tearing and debris. Thus, the gentle massage technique is the appropriate initial management for this condition.