Which procedure is a definitive surgical treatment for acquired NLDO?

• A. Dacryocystorhinostomy
• B. Dacryocystectomy
• C. Canaliculotomy
• D. Conjunctival biopsy

Answer: (A)

Creating a new drainage pathway from the lacrimal sac to the nasal cavity is the definitive surgical treatment for acquired NLDO. Dacryocystorhinostomy establishes a direct bypass around the blocked nasolacrimal duct by forming a rhinostomy between the lacrimal sac and the nasal cavity, allowing tears to drain into the nose. This approach addresses the actual site of obstruction and has high success rates in adults with acquired NLDO, whether done externally or endoscopically. Removing the lacrimal sac (dacryocystectomy) eliminates the sac but does not restore tear drainage, so it is not a definitive treatment for NLDO. Canaliculotomy targets the canaliculi, not the distal nasolacrimal duct obstruction, so it doesn’t resolve acquired NLDO. Conjunctival biopsy is a diagnostic procedure for ocular surface conditions, not a therapeutic solution for NLDO.