06-22-2007, 08:38 AM
A 3-month-old boy is brought to the clinic by his mother because "ever since the child was born he has
had constant tearing from both eyes." She tells you that when the baby wakes up in the morning there is
a small amount of watery discharge at the medial corner of his eyelids and that she must wipe the
child's eyes multiple times throughout the day. The child is developmentally normal and is reaching his
normal milestones. On physical examination the baby is able to fix and follow you with either eye.
Extraocular movements are full. The pupils are round and reactive and there is no relative afferent
papillary defect. The conjunctiva, sclera, and cornea are normal. There is a bit of dry crust on the medial
side of the left lower lid. The most appropriate next step in management is to
A. admit the patient for intravenous antibiotics
B. instruct the mother to apply warm compresses to both eyes 4 times a day
C. instruct the mother to perform nasolacrimal duct massage 2-3 times a day
D. refer the patient to an ophthalmologist for nasolacrimal duct probing
E. take cultures and prescribe topical antibiotics
had constant tearing from both eyes." She tells you that when the baby wakes up in the morning there is
a small amount of watery discharge at the medial corner of his eyelids and that she must wipe the
child's eyes multiple times throughout the day. The child is developmentally normal and is reaching his
normal milestones. On physical examination the baby is able to fix and follow you with either eye.
Extraocular movements are full. The pupils are round and reactive and there is no relative afferent
papillary defect. The conjunctiva, sclera, and cornea are normal. There is a bit of dry crust on the medial
side of the left lower lid. The most appropriate next step in management is to
A. admit the patient for intravenous antibiotics
B. instruct the mother to apply warm compresses to both eyes 4 times a day
C. instruct the mother to perform nasolacrimal duct massage 2-3 times a day
D. refer the patient to an ophthalmologist for nasolacrimal duct probing
E. take cultures and prescribe topical antibiotics