Efficacy of Nasolacrimal Duct Probing in Adult Iraqi Patients with Primary Acquired Obstruction: A Prospective Clinical Study

Abstract

Background: Primary acquired nasolacrimal duct obstruction (PANLDO) represents a significant cause of epiphora in adults, with limited evidence supporting minimally invasive treatment approaches in Middle Eastern populations.

Objective: To evaluate the therapeutic efficacy and safety profile of nasolacrimal duct probing as a primary intervention for adult Iraqi patients with confirmed PANLDO.

Methods: This prospective cohort study enrolled 50 adult patients (≥18 years) with unilateral epiphora secondary to PANLDO at Al-Habboby Teaching Hospital between March 2016 and September 2017. All patients underwent standardized probing procedures using Bowman probes under local anesthesia. Success was assessed through combined subjective symptom evaluation and objective irrigation testing at 1 week, 1 month, 3 months, and 6 months post-procedure.

Results: Complete symptom resolution occurred in 15 patients (30%), with 12 patients (24%) reporting subjective improvement and 3 patients (6%) demonstrating objective patency confirmation. Persistent symptoms were observed in 27 patients (54%), while 8 patients (16%) experienced temporary improvement followed by symptom recurrence. The male-to-female ratio was 27:23. No major complications were reported.

Conclusions: Nasolacrimal duct probing demonstrates moderate efficacy as a first-line treatment for adult PANLDO, offering a low-risk alternative before considering more invasive surgical interventions. The procedure's safety profile and cost-effectiveness support its role in the therapeutic algorithm for adult epiphora management.