From the Research
Lacrimal duct probing should be considered when conservative measures for nasolacrimal duct obstruction have failed after 6-12 months of observation, or sooner if there are recurrent infections, as suggested by the most recent and highest quality study 1. The decision to proceed with lacrimal duct probing is based on the failure of conservative management, which typically includes digital massage of the lacrimal sac 2-3 times daily and topical antibiotics for any acute infections.
- For infants with congenital nasolacrimal duct obstruction, probing is usually delayed until 12 months of age since approximately 90% of cases resolve spontaneously by this time 2.
- However, earlier intervention at 6-9 months may be warranted if the child experiences recurrent conjunctivitis, severe symptoms affecting quality of life, or if the parents strongly prefer earlier treatment.
- The timing of probing is important because success rates decrease with age, particularly after 24 months when fibrosis of the obstruction becomes more established 3.
- Probing works by physically breaking through membranous obstructions in the nasolacrimal system, restoring normal tear drainage and relieving symptoms of epiphora and recurrent infections.
- A systematic review and meta-analysis of randomized clinical trials found that early probing has the same success rate as late probing, with low certainty evidence 1.
- Additionally, evidence of moderate certainty suggests that late probing has a lower success rate than bicanalicular silastic intubation in patients with complex congenital nasolacrimal duct obstruction 1.
- It is essential to weigh the benefits and risks of probing, considering the potential complications, such as creation of a false passage and injury to the nasolacrimal duct, canaliculi, and puncta 2.