Ocular surface irritation and lid mal-positions should be addressed initially. After identification of the site of blockage an appropriate plan of action should be adopted.

Probing of the canaliculi in experienced hands is an effective diagnostic tool.

Partial canalicular blockage can be treated by either DCR and silicone tube insertion or by closed technique canaliculoplasty involving bicanalicular insertion of a stent into the naso-lacrimal duct.

Extensive canalicular blockage requires more complex surgery. Canaliculo-DCR for distal obstruction and DCR with retrograde intubation for proximal obstruction.

Closed technique by-pass surgery with a Lester-Jones tube is the last resort when other techniques have failed to achieve recanalisation of the drainage system.

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