A 4-year-old child with congenital nasolacrimal duct obstruction has been treated with lacrimal sac massage and topical antibiotics for 12 months with persistent epiphora and recurrent mucopurulent discharge. The next step in management is:

• A Continue massage for another 12 months
• B Balloon dacryoplasty
• C Dacryocystorhinostomy
• D Probing of the nasolacrimal duct ✓

Explanation

Congenital nasolacrimal duct obstruction resolves spontaneously with massage in 90% by age 12 months. If persistent beyond 12 months, probing of the nasolacrimal duct is the first-line intervention with high success rates. Balloon dacryoplasty or stenting is reserved for failed probing. Dacryocystorhinostomy is considered only after failed probing and is rarely needed in children.

Reference: Pediatric Ophthalmology and Strabismus (AAO Basic and Clinical Science Course), 2022-2023 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.