Nasolacrimal Duct Obstruction and the Watering Eye – Board-Style Questions

What this deck covers

nasolacrimal duct obstruction in 18 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for paediatric board, MRCPCH and licensing examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 18 cases, in order

1. Tears on the cheek
2. The last few millimetres
3. Time on their side
4. What the parents can do
5. Into theatre at last
6. A blue lump from day one
7. A fold in the lower lid
8. The dye that stays
9. Nowhere for tears to go
10. Why his has not settled
11. Something left behind
12. A new route
13. Off the true path
14. Nothing to grow
15. Worse with a cold
16. Trying again
17. Noisy from the first breath
18. Where the tears end up

Diagnoses and management options tested

Across the 18 cases you are asked to choose between options such as: An allergic reaction to something used on her face at home each day, A membrane at the lower end of the duct that never opened, Roughly half of babies will still be affected at five years, Nothing at all, since any handling could damage the delicate eyelid, Probing under anaesthetic after the first birthday, A bruise from the pressure of an instrumental delivery last night, An allergy to the washing powder used on his bedding, Normal drainage on the left, exactly the same as on the right, Absent puncta, so the tears have no way in at all, His parents have not been massaging firmly enough at home, A drop used every morning for the next three years, Tightening of the lower lid so that it sits against the eye, A false track made beside the true route, Send a swab and start a stronger antibiotic drop while the result is awaited.

Clinical pearls from this deck

• A wet but white eye in a baby: blocked drainage.
• The blockage sits at the very bottom of the duct.
• Most blocked tear ducts open by the first birthday.
• Massage and lid cleaning, not repeated antibiotic drops.
• Still watering after a year: probe it.
• Blue lump by the nose at birth: a distended tear sac.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all ENT and ophthalmology case decks · pediatric reference values.