SynthesisInternational ophthalmology2026
The role of intubation and dacryocystorhinostomy in the management of functional nasolacrimal duct obstruction: a systematic review.
Synthesis in International ophthalmology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo review the role of nasolacrimal intubation and dacryocystorhinostomy (DCR) in functional nasolacrimal duct obstruction (FNLDO).
methodsA systematic search was conducted from inception to the 31st March 2025 on PubMed, EMBASE and Web of Science databases. All studies describing a clinical diagnosis of "functional" obstruction was included. These included studies referencing historical variations of the term "functional block", "partial obstruction" and its associated clinical tests, such as patent syringing and/or positive Jones I and /or I testing", and/or adjunctive imaging including dacryocystogram (DCG) and/or dacryoscintigraphy (DSG). Studies depicting patients < 18 years-old, "complete" acquired nasolacrimal duct obstruction, clear evidence of NLDS; and ongoing epiphora despite prior DCR and anatomical patency were excluded.
resultsThe search yielded 19 studies including 15 retrospective and 4 prospective studies. In 5 studies, patients were clearly defined as FNLDO with patent lacrimal syringing and/or Jones testing, DCG excluding nasolacrimal stenosis, and, if available, DSG to characterise the location of drainage delay. The remaining studies included terms such as "functional block" or "functional epiphora" defined as nasolacrimal duct patency via syringing only; and patent syringing and delayed DSG, without DCG excluding nasolacrimal duct stenosis (NLDS). Two studies were retrospective comparative studies between nasolacrimal intubation and DCR. Complete resolution for endoscopic DCR ranged from 64.7-97.2%, external DCR ranged from 53.8-94.1%; and nasolacrimal intubation ranged from 34.1-76%.
conclusionCharacterising the nature and extent of impaired nasolacrimal tear drainage is imperative in determining the most appropriate intervention. In FNLDO, DCR appears to have higher success rates than nasolacrimal intubation. Intubation represents a less invasive option for patients. Ultimately, determining appropriate management requires patient education and informed consent regarding the available options, efficacy, risks and clinical outcomes.
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