In acquired nasolacrimal duct obstruction, which procedure is commonly performed to restore drainage?

• A. Dilate and irrigate in the office
• B. Massage nasally
• C. Topical antibiotic only
• D. Observation

Answer: (A)

In acquired nasolacrimal duct obstruction, dilating and irrigating in the office is commonly done because it both checks whether the tear drainage pathway is patent and can physically clear partial blockages. By gently passing saline through the punctum into the lacrimal system, debris or mucosal swelling that’s causing a partial obstruction can be flushed out, sometimes restoring normal drainage right away. If the irrigation passes with good flow and little reflux, drainage is likely functional; if it fails, it signals a more significant obstruction that may require further treatment such as surgery. Massage of the lacrimal sac is more typical for certain pediatric or functional scenarios and isn’t the standard initial therapy for adult acquired NLDO. Topical antibiotics address infection but don’t resolve a mechanical blockage, and simply observing won’t restore drainage.