Nasolacrimal Duct Obstruction: What to Do When NLD Probing Fails to Restore Duct Patency
This protocol applies to patients with nasolacrimal duct obstruction who have already undergone nasolacrimal duct (NLD) probing but in whom duct patency was not achieved or not maintained.
Previous Treatment and Failure Condition
The prior line of treatment was NLD probing — a procedure in which a probe is passed through the punctum, along the canaliculus to the lacrimal sac, and through the obstruction into the nares, followed by irrigation to confirm passage. Despite this intervention, the target of patency of the nasolacrimal duct was not achieved, indicating the need for a further step.
Next-Line Approach (Partial Overview)
When initial probing has not restored duct patency, repeat surgical intervention is considered — available approaches involve stent-based or other mechanical techniques directed at the nasolacrimal duct.
Full procedural options, indications, and evidence-based sequence are available via the link below.
References
- A variety of treatment options are available for children requiring repeat surgery.
- Some surgeons simply repeat probing as a first choice.
- Lacrimal stents are used to reduce the risk of recurrent stenosis of the NLD duct.
- They are usually reserved for patients who have persistent symptoms after initial NLD probing.
- Stents are usually left in place for 2-6 months.
- During balloon catheter dilation (BCD), a stent with a balloon at its distal end is passed into the distal nares, the balloon is inflated (typically two times in both the proximal and distal duct), then deflated and removed.
- Infracture of the inferior turbinate, usually done with an instrument such as a periosteal elevator or a hemostat, is sometimes used to decrease the resistance of drainage in the distal nasolacrimal duct.
- If found, distal NLD cysts can be removed with alligator forceps or other instruments via the nostril.
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