Lacrimal system: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Lacrimal system

Sample item

A three-month-old infant has had watering and mucoid discharge from one eye since birth. There is no redness of the eye and no swelling over the lacrimal sac. What is the best initial management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Lacrimal sac massage with conservative care

Congenital nasolacrimal duct obstruction is caused by a membrane at the lower end of the duct (valve of Hasner) and resolves spontaneously in most infants. Initial treatment is hydrostatic sac massage and cleaning, with topical antibiotics for discharge. Probing is reserved for those that persist.

Option by option

  • A. Insertion of punctal plugs

    Punctal plugs block tear drainage and would worsen the watering.

  • B. Lacrimal sac massage with conservative care (correct)

    Correct. Most cases open spontaneously, so conservative care is first line.

  • C. Immediate dacryocystorhinostomy in the clinic

    Dacryocystorhinostomy is a major procedure for older patients with persistent obstruction, not first-line in infants.

  • D. Long-term systemic antibiotics

    Prolonged systemic antibiotics do not relieve a mechanical obstruction.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is B, Lacrimal sac massage with conservative care. Congenital nasolacrimal duct obstruction is caused by a membrane at the lower end of the duct (valve of Hasner) and resolves spontaneously in most infants.

Why is "Insertion of punctal plugs" not the answer?

Punctal plugs block tear drainage and would worsen the watering.

Why is "Immediate dacryocystorhinostomy in the clinic" not the answer?

Dacryocystorhinostomy is a major procedure for older patients with persistent obstruction, not first-line in infants.

Why is "Long-term systemic antibiotics" not the answer?

Prolonged systemic antibiotics do not relieve a mechanical obstruction.

What concept does this question test?

It tests Lacrimal system in Ophthalmology. Initial treatment is hydrostatic sac massage and cleaning, with topical antibiotics for discharge. Probing is reserved for those that persist.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Lacrimal system?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.