Current management strategies of congenital nasolacrimal duct obstructions

Abstract

ABSTRACT Introduction: Congenital nasolacrimal duct obstruction (CNLDO) is characterized by epiphora starting in the first two weeks after birth, representing 90% of the causes of epiphora in childhood. The purpose of this article is to provide information about the main aspects of this important entity. Method: This is an extensive database search, including articles about causes of epiphora in newborns, clinical diagnosis, types and treatments of CNLDO, exploring conservative (massage and antibiotics), or invasive treatment (probing, intubation, balloon catheter dilatation, dacryocystorhinostomy) as well the use of adjuvant treatment. Results: Despite the many controversies related to the CNLDO treatment, the decisions must be based on the natural history of the affection, type of obstruction, and clinical manifestation. Recognizing the types of obstruction (simples or complex) can facilitate choosing the adequate treatment. Nasal endoscopy is the most important tool for CNLDO diagnosis and management, mainly in complex cases, highlighting the variants of CNLDO, optimizing management to achieve better success rates. Endoscopic dacryocystorhinostomy in children can also provide a very good outcome. Conclusion: Simple CNLDO can have a spontaneous resolution or evolve to cure with a massage. However, complex CNLDO must have more attention. Endoscopy can document the efficacy of sondage and provide the opportunity to treat associated nasal alterations detected during the procedure, improving the outcome.