Congenital Naso Lacrimal Duct Obstruction Treatment


Congenital nasolacrimal duct obstructions instinctively resolve in 90% of cases during the first year of birth. Some of the physicians have advocated massage with the digital pressure as an aid to speeding this natural resolution. Other than massage, topical antibiotics were used for the mucopurulent discharge, but the only treatment of the efficacy for those patients who don’t resolve spontaneously is surgery.

Probing:

Probing will cures 95% of the congenital nasolacrimal obstruction cases. Prognosis for the probing will decreases exponentially with increasing number of the probings & the age of the patient. Occasionally, it is successful after the 3rd time or after 3 years.

Nasolacrimal intubation:

It is been advocated as an alternate technique to dacryocystorhinostomy (DCR) in the children who are failed probing.

Success rates of this procedure was 80-95% is been reported, but majority of the patients is only been probed twice or less & are younger than 2 years. Prognosis is poor for those patients who have previous dacryocystitis & for those patients in which the obstruction is been encountered during the procedure.

Ballon catheter dilatation of the nasolacrimal system with or without silicon tubing

This procedure is having bit better results when compared to the intubation alone. Most probing failures will occur as the result of the upper sac or mid duct obstructions & were not open to cure by the instrumentation. Repeat probing techniques & intubation may cause serious complications or risks, which includes false passages, canalicular scarring & stenosis.



Conjunctival dacryocystorhinostomy

If the upper system is scarred or otherwise not amenable to the opening, then it will be bypassed by using prosthesis, like Lester-Jones tube. This procedure probably should be avoided till the child is older than 10 years because of the prosthesis require care from the patient & usually has minor complications & revisions. In punctal agenesis where there is no canalicular tissue is been identified, the insertion of a Lester-Jones tube is necessary.

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