As a less invasive option, which procedure can be used for some NLDO cases before considering DCR?

• A. External dacryocystorhinostomy
• B. Silicone tube intubation
• C. Dacryocystectomy
• D. Canthotomy

Answer: (B)

Silicone tube intubation provides a less invasive option for some NLDO cases before considering DCR. By threading a small silicone tube through the puncta and canaliculi into the lacrimal drainage system, this method bypasses the obstruction and helps maintain patency while the mucosa heals. It can be used when the blockage is not complete or when preserving the existing lacrimal pathway is desirable, and it’s often performed with minimal anesthesia in an outpatient setting. The tube may stay in place for weeks to months to allow healing, making it a practical interim step before committing to the more invasive external DCR. Risks include irritation, tube displacement or extrusion, infection, and granulation tissue. In contrast, external dacryocystorhinostomy creates a new drainage route by bypassing the nasolacrimal duct with a bony connection to the nasal cavity, which is more invasive and is typically considered if intubation doesn’t resolve the issue; dacryocystectomy removes the lacrimal sac altogether and is not a treatment for NLDO; canthotomy addresses other issues and does not treat NLDO.