EFFECTIVENESS OF NON-SURGICAL MANAGEMENT OF CONGENITAL NASOLACRIMAL DUCT OBSTRUCTION

Background: Congenital nasolacrimal duct obstruction is the common disorder leading to epiphora and is usually due to the failure of canalization of nasolacrimal duct. Canalization of the nasolacrimal duct usually occurs by six months of intrauterine life. Common causes of nasolacrimal duct obstruction include the absence or atresia of the canaliculi and puncta, congenital atresia of the duct, the presence of a membrane at the valve of Hasner, absence of valves, lacrimal sac mucocele, blockages, and craniofacial abnormalities.

Methods: The study included 100 babies (108 eyes) under the age of 2 diagnosed with congenital nasolacrimal duct obstruction. Hydrostatic sac massage was performed weekly by the clinician and proper technique was explained to the parents for massaging at home. All babies were followed weekly for 6 months. Successful hydrostatic sac massage was documented when complete resolution of symptoms occurred.

Results: The most common sign of congenital nasolacrimal duct obstruction was mucopurulent discharge (62.96%) followed by epiphora (31.48%), mucocele (3.70%) and lacrimal abscess (1.85%). The overall effectiveness of hydrostatic sac massage in babies below 2 years of age was 80.55% and it was most effective in 6-12 months age group (88.23%). The success rate decreases as age increases.

Conclusion: Hydrostatic sac massage of the nasolacrimal duct is a safe and effective primary treatment option for congenital nasolacrimal duct obstruction in babies under 2 years of age. Results of the study may encourage us to proceed for early non-surgical intervention of CNLDO by hydrostatic nasolacrimal sac massage rather than waiting for spontaneous resolution.