A COMPREHENSIVE REVIEW OF THE INVASIVENESS OF THERAPEUTIC APPROACHES FOR LACRIMAL DRAINAGE DISEASE

To evaluate the invasiveness of various diagnostic and therapeutic interventions for lacrimal drainage disease, including proximal lacrimal obstructions and nasolacrimal duct obstruction (NLDO)

A comprehensive review of literature, comparing qualitative techniques.

A review of recent studies focused on surgical and non-surgical approaches for treating lacrimal drainage disease. Sources included PubMed, MEDLINE, and Google Scholar, covering English abstracts Data from each study were extracted on demographics, clinical presentations, investigative techniques, treatment methods, complications, and outcomes.

Studies highlighted a range of invasive and minimally invasive techniques. Punctoplasty and punctal dilatation with stenting are effective for stenosis. Dacryocystorhinostomy (DC) with retrograde intubation is suitable for proximal canalicular obstructions, while trephination and intubation work for mid and distal obstructions. Thin-prep cytology via sheath-guided dacryoendoscopy offers a less invasive alternative to biopsy for primary acquired nasolacrimal duct obstruction (PANDO), with an 86.4% success rate. Congenital NLDO often resolves spontaneously, but unresolved cases benefit from probing, showing high success regardless of timing. For more invasive needs, DCR (external and endonasal) provides symptomatic relief without differences in patient satisfaction. Silicone tube intubation is preferable for older children, with higher success than probing,

The optimal management of lacrimal drainage diseases varies by obstruction site and patient age. Minimally invasive techniques like thin-prep cytology and endoscopic approaches reduce procedural risks and recovery time while maintaining effectiveness. However, traditional surgical methods like DC remain crucial for specific cases. A tailored approach, balancing invasiveness and patient-specific factors, ensures the best outcomes. Further studies are recommended to standardise treatment protocols, improve patient satisfaction, and explore emerging technologies and methods for better management.