Traumatic nasolacrimal duct obstruction: clinical profile, management, and outcome

To review clinical profile, management, and outcome in cases of traumatic nasolacrimal duct obstruction (NLDO).

A retrospective analysis of 28 patients with the diagnosis of traumatic NLDO during a 12-year period was done. Data regarding nature and pattern of injury, associated damage, clinical features, investigations, management, outcome, and follow-up were reviewed.

Of the 28 patients reviewed in the study, 19 (68%) were male and 9 (32%) were female. Mean age of the patients was 30.1 years. The most common cause of traumatic NLDO was high-velocity blunt injury encountered in road traffic accidents (70%), and the most common pattern of injury was naso-orbito-ethmoidal fractures (64%). Traumatic telecanthus was the most commonly associated periocular injury (54%). Twenty-one patients (75%) were investigated with computed tomography-dacryocystography. A total of 26 patients were treated with external dacryocystorhinostomy with (75%) or without (18%) silicon intubation and 2 (7%) patients underwent dacryocystectomy. General anesthesia was administered in 19 (68%) patients and local anesthesia in 9 (32%) patients. Mean follow-up period was 7.71 months (range 3 months to 6 years). Successful outcome was recorded in 25 out of 26 eyes (96%) operated with external dacryocystorhinostomy with or without silicone intubation.

Naso-orbito-ethmoidal fracture is the main cause of traumatic NLDO, commonly in young male individuals. Telecanthus is an important presenting feature. Computed tomography-dacryocystography is a useful imaging modality in preoperative assessment and surgical planning. External dacryocystorhinostomy with or without intubation under general anesthesia gives good surgical outcome.