Congenital Nasolacrimal Duct Obstruction Management

Congenital nasolacrimal duct obstruction (CNLDO) arises from incomplete canalisation of the nasolacrimal system, resulting in epiphora and mucoid discharge in up to 20% of infants. Most cases resolve spontaneously by 12 months of age. Initial management is conservative, including lacrimal sac massage and topical antibiotics for associated discharge. When obstruction persists beyond the first year or is complicated by infection, minimally invasive interventions are indicated. Primary nasolacrimal duct probing under general or local anaesthesia restores patency in the majority of patients, with success influenced by age and bilaterality. For refractory cases, repeat probing, silicone stent intubation, balloon catheter dilatation or endoscopic-assisted techniques may be employed. Dacryocystorhinostomy remains a reserved option for persistent or complex obstructions. Recent innovations encompass office-based probing with direct visualisation of the ductal lumen, refined stent designs and image-guided approaches that aim to optimise outcomes while minimising anaesthetic exposure. Management protocols now emphasise a stepped approach tailored to patient age, anatomical findings and prior interventions, underscoring the need for early evaluation and coordinated care across paediatric and otolaryngological services.

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Congenital Nasolacrimal Duct Obstruction Management publication trend

The graph below shows the total number of articles in congenital nasolacrimal duct obstruction management across all publications each year (not limited to Nature Index journals).

Technical terms

Epiphora: excessive tearing resulting from lacrimal drainage obstruction.

Probing: a minimally invasive technique using a thin probe to perforate or dilate the obstructed duct.

Dacryoendoscopy: endoscopic visualisation of the lacrimal drainage system for diagnostic and therapeutic purposes.

Lacrimal intubation: insertion of a silicone stent to maintain nasolacrimal duct patency over an extended period.

References

1. Congenital Nasolacrimal Duct Obstruction (CNLDO): A Review. Diseases (2018).
2. Success rates of probing for congenital nasolacrimal duct obstruction at various ages. BMC Ophthalmology (2020).
3. Assessment of Office-Based Probing with Dacryoendoscopy for Treatment of Congenital Nasolacrimal Duct Obstruction: A Retrospective Study. Journal of Clinical Medicine (2023).
4. Mono-canalicular Lacrimal Stent Intubation for Congenital Nasolacrimal Duct Obstruction Treatment. The Open Ophthalmology Journal (2024).
5. Preferred Practice Patterns of Congenital Nasolacrimal Duct Obstruction in Jordan. Clinical Ophthalmology (2023).