Hydrostatic Pressure as an Office Procedure for Congenital Nasolacrimal Duct Obstruction

Background: The estimated incidence of congenital nasolacrimal duct obstruction (CNDO) is 5% to 20%. We examined our success rate of treating CNDO with hydrostatic pressure (the Crigler method) as an office procedure. Methods: A total of 742 children with CNDO initially were treated noninvasively with hydrostatic pressure. The procedure was safely repeated up to 3 times, with an interval of at least 1 week, if the condition persisted. Results: Success was defined as no epiphora or discharge. The success rate for the entire study group was 45% for children up to 1 year of age. The ducts were opened in 46% (343/742) at the first attempt of hydrostatic pressure, in 35% (42/120) at the second attempt, and in 38% (8/21) at the third attempt. When the maneuver was performed in patients younger than 2 months of age, the success rate of the first attempt was 56%, decreasing to 46% in children 2 to 6 months of age and to 28% older than 6 months of age. Conclusions: Hydrostatic pressure is an effective way of resolving infant CNDO and shortening the duration of the associated morbidity. The success rate is higher when the procedure is conducted in patients up to 2 months of age. Nevertheless, we recommend this approach for every infant presenting with CNDO at the first office visit, even after 6 months of age. Procedures can be repeated safely and successfully.