A 50-year-old woman presents with a chronic non-tender medial canthal mass with mucous reflux on digital pressure over the lacrimal sac. Dacryocystography reveals a complete nasolacrimal duct obstruction below the common canaliculus. The preferred surgical treatment is:
- A Dacryocystorhinostomy (DCR) — creating a rhinostomy between lacrimal sac and nasal mucosa ✓
- B Silicone tube intubation of the nasolacrimal duct
- C Probing and syringing of the nasolacrimal system
- D Punctoplasty and canalicular stenting
Explanation
Complete nasolacrimal duct obstruction (NLDO) below the common canaliculus with chronic dacryocystitis (mucous/mucopurulent reflux = Jones test II negative) is the classic indication for DCR, which creates a new drainage pathway between the lacrimal sac and nasal cavity, bypassing the obstructed duct. External DCR (success rate ~90%) or endoscopic endonasal DCR (equivalent success, no scar) are standard approaches. Probing/syringing may work for stenosis but not for complete obstruction. Punctoplasty addresses punctal stenosis. Silicone tube intubation may help in partial obstruction but is insufficient for complete obstruction.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.