Most infants with NLDO persisting past six months resolve without surgery

This analysis of results from a recent multicenter randomized trial found that nasolacrimal duct obstruction (NLDO) frequently resolves within six months without surgical management in infants six months to less than 10 months of age.

Subjects were 107 infants in this age range with NLDO and no history of nasolacrimal duct surgery who underwent either immediate probing in an office setting or were prescribed six months of nasolacrimal duct massage and topical antibiotics as needed.

More than half (66 percent) of eyes showed resolution defined as the absence of all clinical signs of NLDO with nonsurgical management within six months. None of the baseline characteristics evaluated age, sex, laterality, prior treatment, and specific clinical signs of NLDO were found to be associated with resolution without surgery.

The authors note that nearly 20 percent of eyes in which NLDO appeared to have resolved after six months of nonsurgical management showed signs of NLDO when reassessed one to four months later at 18 months of age. It is possible that symptoms and signs of NLDO are intermittent and that, despite appearing clear of signs on a given day, some eyes might have NLDO requiring surgery. Another possibility is that NLDO signs observed at a given visit might be produced or exacerbated by wind, direct sunlight or the presence of an upper respiratory tract illness.