title: [Minimally invasive diagnostics and therapy of congenital nasolacrimal duct obstruction].
abstract: BACKGROUND
  One of the most frequent issues in pediatric ophthalmology concerns congenital nasolacrimal duct obstruction (CNLDO). Typically, irritation of the medial eyelid angle occurs during the first days of life and later increased epiphora appears as tear production is still reduced in young infants. In the case of intrasaccal or postsaccal nasolacrimal duct stenosis, a chronic dacryocystitis develops.
  
  
  METHODS
  Modern minimally invasive diagnostics and therapy of CNLDO are reviewed by means of a search of the recent literature and reflection of own experiences.
  
  
  RESULTS
  An early diagnosis of CNLDO is desirable. If conservative therapeutic approaches fail, invasive procedures have to be considered. Probing and high pressure syringing of the nasolacrimal ducts remains the therapy of choice. Further therapy options, such as balloon dacryoplasty and dacryoendoscopy are also available. Additionally, due to improvement of the surgical techniques a minimally invasive approach is possible even for dacryocystorhinostomy; nevertheless, this procedure should be considered only as a last resort.
  
  
  CONCLUSIONS
  Precise classification of CNLDO and knowledge about the possible treatment options are important. Lacrimal surgery in childhood is dominated by transcanalicular procedures. Advanced minimally invasive techniques, such as dacryoendoscopy or modern autostable intubation sets have to be emphasized. All therapeutic interventions can be summarized using a staged therapeutic concept, which should be used individually and patient-centered.
authors.affiliation: Universitätsklinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland. jens.heichel@uk-halle.de.
authors.forename: J
authors.initials: J
authors.lastname: Heichel
authors.affiliation: Universitätsklinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
authors.forename: H-G
authors.initials: HG
authors.lastname: Struck
mesh_terms: D003131:Combined Modality Therapy / Q000379:methods; D003608:Dacryocystorhinostomy / Q000379:methods*; D003937:Diagnosis, Differential; D004724:Endoscopy / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D007440:Intubation / Q000379:methods; D007767:Lacrimal Duct Obstruction / Q000151:congenital / Q000175:diagnosis* / Q000628:therapy*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009887:Ophthalmoscopy / Q000379:methods*; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome
keywords: Dacryoendoscopy; Dacryostenosis; Lacrimal duct intubation; Lacrimal duct syringing; Pediatric ophthalmology