to report 10-year results of a novel one-stage obstruction-based endoscopic approach in children with congenital nasolacrimal duct obstruction (CNLDO).

Diagnosis was based on history of tearing/ discharges since or shortly after birth and confirmation on the dye disappearance test. Severity of epiphora, previous lacrimal procedure(s) was recorded. Included were patients with primary CNLDO of > 6 months old and no improvement after at least 6 weeks conservative management, previously failed probing/intubation, acute dacryocystitis or dacryocele at any age, and at least 6 months follow up. Patients with complete punctal/canalicular obstruction, craniofacial anomaly, and incomplete follow up were excluded. Endoscopic probing was performed for membranous (simple), intubation for incomplete complex (Not simple but probe can reach the inferior meatus), and dacryocystorhinostomy for complete complex (probe cannot pass through the obstruction) CNLDO. Success was defined as no or intermittent watery eye in cold weather at least 6 months after surgery.

In a retrospective study, 200 patients (226 eyes) were included. Mean age was 26.72 months. Acute dacryocystitis was observed in 17 eyes (7.5%), dacryocele in 3 eyes (1.3%), and intranasal mucocel in 7 eyes (3%). Previous probing or intubation was in 34.1%. Munk grade 4 and 5 were reported in 73%. Inferior turbinate impaction in 73.5% and septal deviation in 2.7% were observed. Membranous CNLDO was found in 38.9%, incomplete complex in 57.9%, and complete complex in 3.1%. Mean time of tube removal was 11.9 weeks and last follow up time was 24.3 months. Final success rates were 96.5%, 95.4%, and 100% for endoscopic probing, intubation and DCR, respectively.

One-stage, obstruction-based endoscopic approach to CNLDO resulted in a high success rate for all the procedures (probing, intubation, and DCR) for different types of CNLDO with primary, previously failed, and complicated forms (mucocel, acute dacryocystitis).