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We thank Dr Frankel for emphasizing the primary treatment for congenital dacryostenosis. He refers to several studies that indicate that persistent lacrimal sac massage usually will result in resolution of the stenosis within seven to 13 months of age, alleviating the need for probing and possible intubation. While we prefer earlier probing than does Dr Frankel, it does not need to be done under general anesthesia as originally stated. In fact, lacrimal duct probing in infants younger than 1 year of age usually is done in the office without anesthesia on two or three occasions before resorting to a general anesthetic with possible intubation. Probing, whether early or late, usually is curative.In our opinion, probing of the nasolacrimal duct should be performed if three months of diligent nasolacrimal duct massage is ineffective to prevent recurrent bouts of conjunctivitis and potential corneal ulceration.
Cowden JW, Bergmann MT. The Treatment of Dacryostenosis-Reply. JAMA. 1988;260(18):2666. doi:10.1001/jama.1988.03410180074032