Congenital nasolacrimal duct obstruction update study (CUP study): Paper II - Profile and outcomes of complex CNLDO and masquerades

Outcome of monocanalicular intubation for complex congenital nasolacrimal duct obstruction: the role of age

“…This type is termed simple CNLDO, while various other pathologies in the NLD are classified as "complex" and account for 16.8-17.8% of all cases of CNLDO [10,12]. Some of the etiologies include mal-development or non-development of bony NLD (absence or narrowing of bony canal of NLD or blind lacrimal fossa) [13], NLD extending lateral to nasal mucosa, thick membranous obstruction of Hasner's valve, multiple level NLD blocks, diffuse NLD stenosis, fibrosis of NLD, various genetic or craniofacial syndromes (trisomy 21, Crouzon syndrome, Treacher-Collins syndrome, cleft lip, cleft palate, and facial clefts) [14,15], lateralized or impacted anterior end of inferior turbinate, or buried probe [10,16]. Various pathologies in the lacrimal system also cause epiphora in the infants and children, but are not anatomically localized to the NLD, so they were not listed among etiologies of complex CNLDO.…”

“…These are known as simple CNLDO, while various other pathologies can arbitrarily be grouped as complex CNLDO [9]. In complex (or complicated) CNLDO, various treatment modalities may be used, including NLD intubation, balloon dacryoplasty, endoscopic interventions and dacryocystorhinostomy [10].…”

Co-existing lacrimal drainage anomalies in eyes with congenital Glaucoma

“…10 CNLDO was diagnosed as simple and complex based on the findings during irrigation and probing, and endoscopy findings. 11,12 The lacrimal irrigation and probing were performed using standard techniques, and the findings were recorded. Post-probing, clinical reassessment was performed at 1-2 weeks, and further glaucoma intervention was scheduled as appropriate.…”

CNLDO: choose endoscopy-guidance and NOT a blind procedure

“…Several papers have shown the benefits of endoscopyguided probing in patients with CNLDO, more so in the complex variants of CNLDO. [1][2][3][4][5] There are several instances where endoscopy plays diagnostic and therapeutic roles in variants of CNLDO, for example, buried probe, misdirected probes, and congenital dacryocele. [4][5][6] It also plays a crucial role in further management of a failed probing.…”

“…[1][2][3][4][5] There are several instances where endoscopy plays diagnostic and therapeutic roles in variants of CNLDO, for example, buried probe, misdirected probes, and congenital dacryocele. [4][5][6] It also plays a crucial role in further management of a failed probing. Even simple cases of CNLDO have the potential to get complicated in the absence of direct visualization.…”