What is considered the gold standard treatment for a nasolacrimal duct obstruction?

• A. Balloon dacryoplasty
• B. Dacryocystorhinostomy (DCR)
• C. Dacryocystectomy
• D. Medical therapy

Answer: (B)

Restoring tear drainage in nasolacrimal duct obstruction is best achieved by creating a new drainage route from the lacrimal sac into the nasal cavity, bypassing the blocked duct. Dacryocystorhinostomy does this by forming an ostium between the lacrimal sac and the nasal cavity, keeping it patent and allowing normal drainage. It offers the highest long-term success and durable relief from epiphora compared with other approaches. Balloon dacryoplasty may be less durable and more likely to fail over time, medical therapy cannot fix an anatomical blockage, and dacryocystectomy removes the lacrimal sac without restoring drainage. Hence, dacryocystorhinostomy is the gold standard for NLDO.