The treatment of congenital nasolacrimal duct obstruction (CLNDO) has long been a subject of debate, especially about the optimum age to intervene. This debate has centered on 3 issues: (1) the spontaneous resolution rate and when it declines, (2) the success of initial nasolacrimal duct probing and how it is affected by age, and (3) the preferred site of service. In this issue of JAMA Ophthalmology, Sathiamoorthi et al address the first 2 issues.1 When the spontaneous resolution rate is high, fewer children need probing. However, the tradeoff for the chance of avoiding surgery and in many cases general anesthesia is additional months of CNLDO symptoms while awaiting resolution. Concern has been voiced by some clinicians that the delay in probing, with more months of symptoms, may be associated with scarring of the nasolacrimal duct and could be in part cause for lower success following simple probing in older children.
Repka MX. Timing of Simple Probing for Congenital Nasolacrimal Duct Obstruction: Not So Simple. JAMA Ophthalmol. 2018;136(11):1286–1287. doi:10.1001/jamaophthalmol.2018.3855
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