Management of acquired nasolacrimal duct obstruction in a bullock

Introduction

The nasolacrimal apparatus provides drainage of tears from the ocular surface into the nasal cavity. Obstruction of this drainage pathway commonly manifests as epiphora and may be associated with periocular moisture, dermatitis, conjunctival irritation, or mucopurulent discharge. Irrigation of the nasolacrimal duct is useful both diagnostically and therapeutically because reflux or failure of passage of fluid can indicate obstruction, while successful flushing may restore ductal patency (MSD Veterinary Manual, 2026) [5] . Nasolacrimal disorders in cattle may broadly be classified as congenital structural anomalies or acquired obstruction. Congenital abnormalities include supernumerary openings, ectopic ducts, fistulae, and other developmental defects. Supernumerary openings of the nasolacrimal drainage apparatus were reported in Brown Swiss calves by Heider et al. (1975) [3] , while Braun et al. (2014) [1] documented a potentially hereditary nasolacrimal duct fistula in Brown Swiss cattle. Congenital lacrimal fistulae have also been reported in calves and bulls, where an abnormal cutaneous opening communicates with the nasolacrimal system (Braun et al., 2012; Jugant et al., 2019) [2,4] . Unlike these congenital anomalies, acquired nasolacrimal duct obstruction represents loss or impairment of previously established ductal patency. In cattle, acquired obstruction may be associated with inflammatory material, mucus, foreign bodies, trauma, or secondary stenosis. In appropriate cases, flushing of the duct can re-establish normal tear drainage (MSD Veterinary Manual, 2026) [5] .

Clinical Observation

A bullock was presented with a history of persistent unilateral excessive lacrimation. Clinical examination revealed continuous overflow of tears from the affected eye with wetting of the periocular region. Detailed ophthalmic examination did not reveal significant corneal lesions, severe conjunctivitis, or another obvious ocular cause for the epiphora. Other clinical parameter like respiration rate 22 breath per min, heart rate 56 beats per min, rectal temperature 101.4 ºf, mucous membrane pink, appetite, defecation, urination were normal. Paravet was previously treated animal with antibiotic enrofloxacin, NSAID meloxicam, antihistamine chlorphenaramine maleate and topical eye drop moxifloxacin and dexamethasone but animal did not show any recovery. The medial canthal region was examined carefully for the presence of an ectopic lacrimal opening or fistula. No abnormal cutaneous opening suggestive of a congenital nasolacrimal fistula was identified. The clinical findings, together with the absence of an apparent congenital anomaly, were suggestive of an acquired nasolacrimal drainage obstruction.

Diagnosis

The nasolacrimal drainage system was evaluated by flushing through the lacrimal punctum with the infant feeding no. [2,1] .

Treatment and Management

The animal was adequately restrained, and the periocular region was cleaned before the procedure. The affected lacrimal punctum was identified and gently cannulated with infant feeding tune no.6 (Fig. 1). Sterile normal saline was slowly introduced into the nasolacrimal duct under controlled pressure. Initial resistance was encountered, but repeated gentle flushing resulted in restoration of ductal patency. Care was taken to avoid excessive pressure because forceful irrigation may traumatize the delicate mucosa or create a false passage. Nasolacrimal flushing is recognized as an appropriate approach for re-establishing ductal patency in cases of obstruction. Following flushing, topical ophthalmic medication like Pendistrin SH (Penicillin Streptomycin sulphate Sulphamerazine Hydrocortisone acetate) used to counteract conjunctival inflammation or secondary infection is present. To avoid the recurrence of inflammation tarsorraphy was done by giving auriculopalpebral nerve block (Fig. 2). Tarsorraphy suture were removed after 10 days. The animal was monitored for recurrence of epiphora and other ocular abnormalities. Following restoration of nasolacrimal duct patency, a marked reduction in lacrimation was observed. The affected eye subsequently showed normal tear drainage, with resolution of periocular wetness. Follow up treatment include injection dicrysticin (procaine penicillin G, penicillin G sodium, and streptomycin sulphate) 5 gm intramuscularly, injection Cadistin (chlorphenaramine maleate) 10 ml intramuscularly, injection melonex (meloxicam) 20 ml intramuscularly and Placentrex (Placenta extract) 2 ml intramuscularly for 3 days. No recurrence of excessive lacrimation was observed during the 15 days of procedure (Fig. 3).

Discussion

Nasolacrimal duct obstruction should be considered in cattle presenting with persistent unilateral epiphora after other painful ocular conditions have been excluded. A careful examination of the medial canthal region is particularly important because congenital fistulae may resemble ordinary lacrimal discharge. Congenital nasolacrimal fistulae have been documented in Brown Swiss cattle, calves, and bulls, and some reports suggest a hereditary component (Braun et al., 2012; Braun et al., 2014) [2,1] . Congenital abnormalities should be distinguished from acquired obstruction because their management differs. Congenital fistulae represent abnormal anatomical communication and may require surgical correction rather than simple flushing. Congenital lacrimal fistulae in calves have been treated by resection and closure of the ectopic duct with placement of a nasolacrimal stent (Jugant et al., 2019) [4] . In contrast, flushing is particularly useful when the duct is anatomically present but its lumen is temporarily or partially obstructed. Restoration of patency following gentle irrigation provides both diagnostic and therapeutic evidence of an acquired obstruction. The successful outcome in the present bullock indicates that early recognition and appropriate flushing can provide a simple, minimally invasive treatment option for selected cases.

Conclusion

The present case demonstrates successful management of acquired nasolacrimal duct obstruction in a bullock by gentle flushing through the lacrimal punctum. Importantly, congenital nasolacrimal abnormalities such as fistulae and ectopic openings should be distinguished from acquired obstruction because they represent structural defects and may require surgical correction. In cattle with epiphora and no evidence of a congenital anomaly, careful ophthalmic examination followed by controlled nasolacrimal flushing can be an effective diagnostic and therapeutic approach. Early restoration of tear drainage may prevent persistent periocular wetness, secondary dermatitis, and recurrent ocular irritation.

References

1. Braun U, Jacober S, Drögemüller C. Congenital nasolacrimal duct fistula in Brown Swiss cattle. BMC Vet Res. 2014;10:44. doi:10.1186/1746-6148-10-44.
2. Braun U, Spiess B, Matheis F, Schnetzler C, Trösch L, Drögemüller C, et al. Bilateral congenital lacrimal fistula in a Brown Swiss bull. Schweiz Arch Tierheilkd. 2012;154(3):121-123. doi:10.1024/0036-7281/a000310.
3. Heider L, Wyman M, Burt J, Root C, Gardner H. Nasolacrimal duct anomaly in calves. J Am Vet Med Assoc. 1975;167(2):145-147.
4. Jugant S, Robin MC, Regnier A, Cassard H, Herman N, Conchou F, et al. Congenital lacrimal fistula in two Prim'Holstein calves. Vet Ophthalmol. 2019;22(3):368373. doi:10.1111/vop.12640.
5. MSD Veterinary Manual. Nasolacrimal and lacrimal apparatus in animals. 2026.