What is the treatment for dacryostenosis?

Treatment for Dacryostenosis

The treatment for dacryostenosis follows a stepwise approach, with probing of the lacrimal drainage system being the first-line surgical intervention for cases unresponsive to conservative management. 1

Understanding Dacryostenosis

Dacryostenosis refers to the narrowing or obstruction of the lacrimal drainage system, which can occur at various points along the pathway. It can be:

• Congenital (common in infants)
• Acquired (due to trauma, inflammation, or aging)

Treatment Algorithm

1. Conservative Management (Initial Approach)

For congenital dacryostenosis:

• Lacrimal sac massage
• Topical antibiotic eye drops
• Detumescent nose drops
• Observation for spontaneous resolution (common in infants) 2

For acquired dacryostenosis:

• Artificial tears and lubricants
• Treatment of any underlying inflammatory conditions

2. Minimally Invasive Procedures

If conservative management fails:

• Lacrimal probing: High-pressure irrigation with hollow probe

  • Highly effective first-line surgical approach
  • For congenital cases, typically performed after 5-6 months of age if conservative measures fail 2
  • Success rates are high regardless of timing, but early intervention helps identify possible maldevelopments 1

• Repeated probing:

  • Considered for cases unresponsive to initial probing without evident lacrimal outflow dysgenesis
  • Similar effectiveness to more invasive procedures 1

3. Advanced Interventions

For cases resistant to probing:

• Dacryointubation:

  • Placement of silicone tubes to maintain patency
  • Highly effective for cases unresponsive to repeated probing 1
  • Tubes may remain in place for extended periods

• Dacryocystorhinostomy (DCR):

  • Gold standard for nasolacrimal duct obstruction with patent canaliculi
  • Two major approaches:
    • External DCR (via transcutaneous incision)
    • Endonasal endoscopically guided DCR
  • High success rate (up to 94% in posttraumatic cases) 3
  • Indicated for chronic dacryocystitis and complete obstructions 4, 5

Special Considerations

Acute Inflammation

• Treat inflammation first before addressing the stenosis
• May require incision of abscess (transcutaneous or endonasal) 2

Trauma-Related Dacryostenosis

• Early reconstruction with lacrimal intubation after trauma
• External DCR with large rhinostomy for established posttraumatic dacryostenosis 3, 5

Congenital Cases

• High rate of spontaneous resolution (approximately two-thirds of cases)
• One-third of recurrences after initial probing may be related to maldevelopments requiring more invasive management 1

Follow-up Care

• Post-procedure antibiotic and detumescent drops for 1-2 weeks
• Regular monitoring to ensure patency of the lacrimal system
• For DCR procedures, monitoring for scarring and rhinostomy patency

Conclusion

The management of dacryostenosis should follow a progressive approach from conservative measures to more invasive surgical interventions based on response to treatment and underlying pathology. Early intervention, particularly in congenital cases that don't resolve spontaneously, helps identify structural abnormalities and improves outcomes.