Dacryological Interventions for Nasolacrimal Duct Obstruction

Nasolacrimal duct obstruction (NLDO) presents with impaired tear drainage leading to persistent epiphora, recurrent infections and, in severe cases, corneal complications. A spectrum of interventions has been developed to restore patency and preserve ocular health. Traditional external dacryocystorhinostomy (DCR) remains a gold standard, creating a new drainage route between the lacrimal sac and nasal cavity. Endoscopic approaches offer minimally invasive alternatives, with the potential for reduced scarring and faster recovery. Adjunctive measures—such as intraoperative antimetabolites, silicone stents and refined irrigation techniques—have been explored to enhance long-term success and reduce restenosis. Diagnostic advances, including syringing tests and anterior segment optical coherence tomography, enable precise evaluation of canalicular anatomy and obstruction sites. Together, these developments underscore a shift towards personalised, less invasive care pathways that balance efficacy, safety and patient comfort on a global scale.

Research from Nature Portfolio

Recent studies have refined diagnostic and surgical strategies for NLDO. One investigation of the lacrimal syringing test in patients with non-infectious corneal perforation revealed a high prevalence of occult lacrimal drainage disease, underscoring the test’s value in identifying nasolacrimal blockages that contribute to corneal ulceration. This work emphasises early screening to prevent sight-threatening sequelae. Another meta-analysis comparing external DCR with and without silicone intubation demonstrated that stenting confers a statistically significant improvement in anatomical patency and symptomatic relief, particularly in external approaches. While no clear advantage was seen in endoscopic subgroups, the findings support selective use of intubation to bolster success in primary and revision procedures.

Dacryological Interventions for Nasolacrimal Duct Obstruction publication trend

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

Technical terms

Dacryocystorhinostomy (DCR): Surgical creation of a direct fistula between the lacrimal sac and nasal cavity to bypass an obstructed nasolacrimal duct.

Epiphora: Excessive tearing due to inadequate drainage through the nasolacrimal system.

Lacrimal syringing test: A diagnostic irrigation of the lacrimal passages with saline to assess site and severity of obstruction.

Silicone intubation: Placement of a silicone stent within the nasolacrimal system during or after DCR to maintain duct patency.

Mitomycin C: An antimetabolite agent applied intraoperatively to inhibit fibroblast proliferation and reduce surgical site scarring.

References

1. Proportion and characteristics of lacrimal drainage pathway disease and keratopathy in non-infectious corneal perforation using lacrimal syringing test. Scientific Reports (2023).
2. Comparing the Success Rate of Dacryocystorhinostomy With and Without Silicone Intubation: A Trial Sequential Analysis of Randomized Control Trials. Scientific Reports (2017).
3. Efficacy of Mitomycin C in Endoscopic Dacryocystorhinostomy: A Systematic Review and Meta-Analysis. PLOS ONE (2013).
4. The microbiologic spectrum of dacryocystitis. BMC Ophthalmology (2021).
5. A comparative study of irrigation techniques and the development of a self-serve training model for ophthalmology residents. BMC Medical Education (2025).
6. Evaluation of the Lower Punctum Parameters and Morphology Using Spectral Domain Anterior Segment Optical Coherence Tomography. Journal of Ophthalmology (2015).