Congenital nasolacrimal duct obstruction (CNLDO) is a common reason for admitting to oculo-facial visit. Traditionally, simple nasolacrimal probing has been gold standard surgical intervention for the management of CNLDO. However, it is a blind procedure that carries the risk of false passage formation and iatrogenic trauma to nasolacrimal system and nasal cavity. Nasal endoscopy may decrease the chance of false passage. Furthermore, by proving direct vision of the anatomy at terminal end of nasolacrimal duct may specify the pathogenesis of CNDLO. Thus, effective treatment directed to the pathogenic factor. We assumed that this may help to increase the chance of the first time probing in primary CNLDO and decrease the reoperations. In this study we aimed to common results endoscopic-assisted probing with simple probing in children with CNLDO.to minimize nasal mucosal trauma, decreases the chance of creating a false passage and provides the optimum management option of different congenital variants of nasolacrimal duct obstruction.

Children with primary congenital nasolacrimal duct obstruction were included in a single blind randomized clinical trial. All children underwent comprehensive ophthalmology exam, assessment of epiphora, discharge, orbito-facial abnormalities, fluorescein dye disappearance test (FDDT) before and after surgery. Eligible patients were randomly assigned to simple probing (group 1) or nasal endoscopy assisted probing (group 2). Failure of intervention was defined if each of the following existed: epiphora, discharge, abnormal FDDT. The minimus follow up time was 3 months.

352 children with CNLDO were analyzed. The age range was 19.7 (SD= 11.5) months. Male to female ratio was 320 (58.5%): 227 (41.5%). Type of obstruction included simplex (83.5%), partially complex (7.0%), complete complex (1.4%) and functional 8.1 %. Overall success rate was 86.1% and 93.8% in group 1 and group2 respectively (p=0.04).no remarkable complication was observed in either groups.

Endoscopy assisted probing can result in higher successful probing in patients with primary CNLDO. The impact of endoscopy was more prominent in those with intranasal, concha abnormalities and those with concealed probe.