Congenital Nasolacrimal Duct Obstruction: Natural Course, Diagnosis and Therapeutic Strategies

Congenital nasolacrimal duct obstruction (CNLDO) is a prevalent condition in newborns, characterized by lacrimation excess due to anatomic occlusion of the nasolacrimal ducts (NLD). This narrative review provides a comprehensive overview of CNLDO, encompassing its etiology, epidemiology, clinical manifestations, diagnosis and current treatment options. Diagnosis comprises the fluorescein dye disappearance test (FDDT) and imaging studies. In most cases, CNLDO resolves spontaneously within the first year of life. However, if spontaneous resolution does not occur, or if complications arise during observation period, treatment with conservative methods such as massage is introduced earlier, depending on the severity and complexity of the case. If these methods prove unsuccessful, more invasive procedures, including probing, intubation or dacryocystorhinostomy, are employed. While early diagnosis is crucial, its direct impact on treatment outcomes is more related to the prompt identification of cases that may require escalation of care.