A 55-year-old woman with epiphora and mucopurulent discharge has nasolacrimal duct obstruction (NLDO). Syringing and probing confirm distal NLDO. She has undergone probing twice without success. The DEFINITIVE surgical treatment is:
- A Repeat silicone tube intubation
- B Punctal dilation and repeated probing
- C Dacryocystorhinostomy (DCR) — creating a new ostium from the lacrimal sac into the nasal mucosa ✓
- D Conjunctivodacryocystorhinostomy (CDCR) with Jones tube
Correct answer: C. Dacryocystorhinostomy (DCR) — creating a new ostium from the lacrimal sac into the nasal mucosa
Explanation
Dacryocystorhinostomy (DCR) is the gold-standard treatment for complete NLDO, creating a new drainage passage directly from the lacrimal sac to the nasal cavity (middle meatus) bypassing the blocked nasolacrimal duct. External DCR has a success rate of 90–95%. Endoscopic (endonasal) DCR offers equivalent outcomes without a skin incision. Repeat silicone tube intubation is indicated for partial obstruction, not complete NLDO after failed probing. CDCR with Jones tube is reserved for proximal canalicular obstruction (canalicular block) — not for NLDO.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.