Congenital nasolacrimal duct obstruction update study (CUP study): Paper V – atonic lacrimal sac in CNLDO

PurposeTo describe the clinical features, intraoperative findings, and management outcomes of children with congenital nasolacrimal duct obstruction (CNLDO) complicated by atonic lacrimal sac.MethodsA retrospective review was conducted on children diagnosed with CNLDO and intraoperatively confirmed atonic lacrimal sac between January 2017 and December 2023 at two tertiary centers. Data included demographics, clinical findings, type of obstruction, intervention, and outcomes. Success was defined as normal fluorescein dye disappearance with absence of epiphora or discharge.ResultsSixty-eight eyes of 65 children (median age, 3.5 years; range, 6 months-12 years; 60.3% males) were analyzed. Membranous obstruction was identified in 82.4% and firm obstruction in 16.2% of eyes. Probing alone was performed in 55 eyes (80.9%), while probing with additional intraoperative procedures were performed in 13 (19.1%), including silicone intubation in 11 and balloon dacryoplasty in 2. Success after the primary procedure was 67.6% at a mean follow-up of 9.9 ± 14.9 months. Younger age and membranous obstruction correlated with higher success. The additional procedures with probing did not have a significant impact on successful outcomes. Of 22 failures, 13 underwent secondary Dacryocystorhinostomy (DCR), all achieving complete anatomical and functional resolution.ConclusionsAtonic lacrimal sac represents an uncommon subtype of complex CNLDO. Most cases respond favorably to standalone probing combined with prolonged lacrimal sac compressions, particularly in younger children with membranous obstruction. DCR remains an effective second-line treatment for refractory cases.