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Surgical management of congenital nasolacrimal duct obstruction; one procedure for all versus all procedures for one

Kashkouli, Mohsen B.; Karimi, Nasser; Khademi, Behzad

Current Opinion in Ophthalmology: September 2019 - Volume 30 - Issue 5 - p 364–371
doi: 10.1097/ICU.0000000000000584

Purpose of review After failed conservative management, most clinicians treat congenital nasolacrimal duct obstruction (CNLDO) in a conventional stepwise fashion: starting with probing, then repeat probing, next silicone intubation and/or balloon dilatation, and finally dacryocystorhinostomy. This approach is based on the patient's age and previously failed procedures and recruits ‘one procedure for all’ CNLDO. A newly introduced approach is based on the type of obstruction and recruits ‘all procedures for one’ CNLDO. The aim of this review is to examine the best available evidence regarding CNLDO management.

Recent findings Recent articles support the concept that through intraoperative evaluation of obstruction in CNLDO, clinicians may predict probing failure and instantaneously employ more appropriate treatment modalities. This review addresses whether an age-based approach should be changed into a one-stage obstruction-based approach.

Summary An age-based approach treats CNLDO as a homogeneous disease and thus treats all patients with one predetermined procedure. A one-stage obstruction-based approach, however, considers CNLDO to be a heterogeneous disease, and therefore allows recruitment of all procedures simultaneously and selects the best intraoperatively. It may allow replacement of the conventional stepwise approach to CNLDO treatment provided that randomized trials verify its efficacy, safety, and cost-effectiveness.

Video abstract

Eye Department, Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

Correspondence to Mohsen B. Kashkouli, MD, Eye Research Center, Rassoul Akram Hospital, Sattarkhan Niayesh St., Tehran 1455364, Iran. Tel/. fax: +9821 66558811; e-mail:

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