Kakizaki et al We examined the resolution of CNLDO by conservative management in Japanese infants before their ﬁrst year of age. Patients and methods Thirty-ﬁve nasolacrimal ducts in 27 patients (8 patients were bilateral; 15 were on the right side and 20 on the left; 11 patients were males and 16 females), diagnosed with CNLDO were retrospectively examined. Patients were observed every month until 12 months of age at most, and were examined and managed with or without the resolu- tion of epiphora with only conservative management such as lacrimal massage or antibiotic eye drops. Lacrimal sac massage was administered to all children (10 pushes/time, twice daily), following the procedures of Crigler (1923) or Kushner (1982). When patients showed deﬁnite conjuncti- vitis, antibiotic eye drops (levoﬂoxacin 4 times/ a day) were prescribed, and used maximally within a week. All patients, except for 1 delivered at 34 weeks, were delivered at normal term. The diagnosis of CNLDO was made from the clinical course and ﬂuorescein disappearance test (MacEwen and Young 1991a). Other forms of epiphora, such as epiblepha- ron, congenital entropion, congenital glaucoma, keratitis, uveitis and patients with facial malformations (Young and MacEwen 1997; Hanavar et al 2000; Kashkouli et al 2002), were not included in the study. The resolution of CNLDO was judged by the improvement of epiphora and from the ﬂuorescein disappearance test (MacEwen and Young 1991a). Syringing was not performed to conﬁrm CNLDO and its resolution. Patients with symptoms after 12 months of age underwent probing, the success of which was conﬁrmed by syringing using normal saline solution with ﬂuorescein. For these patients, lacrimal massage was continued up to the day probing was undertaking. Statistical analyses were performed with a chi-square test, and a P-value less than 0.05 was judged as statistically signiﬁcant (SPSS 8.0J : SPSS Japan Inc, Japan). Results No patients were excluded because of complete follow-up. However, one side in a patient who presented with dacryo- cystitis underwent early probing before 12 months of age (Kashkouli et al 2002). In addition, another patient with unilateral symptoms showed discharge throughout the day, because of which severe eyelid erosion was shown. Antibi- otic eye drops could not improve this symptom, which was improved by probing before 12 months of age. These 2 sides in 2 patients were included in the non-improved group. 292 Twenty-nine sides of 21 patients (13 right and 16 left; 10 male patients and 11 female) successfully resolved with just conservative management (82.9%). In the 29 sides, 16 resolved before 6 months of age, and one at 12 months of age (Table 1). Based on these data, the ﬁnal possibility of resolution in each month was calculated until 12 months of age (Table 1). Eight patients with bilateral symptoms resolved simultaneously or within 3 months after contralateral resolution (Table 2). The patient born at 34 weeks gestation recovered from the symptoms at 10 months of age. Four naso- lacrimal ducts in 4 patients without resolution of CNLDO during the observational term (1 male, left side; 3 females, 1 right side and 2 left) underwent probing under topical anaes- thesia at 13 months of age, all were conﬁrmed as resolved after the procedure. There were no signiﬁcant differences in sex (p = 0.381) or laterality (p = 0.452) for the rate of the CNLDO resolution under conservative management. Discussion In the present study, 82.9% of CNLDO in Japanese infants resolved with the conservative management before the 1st year of age. The percentages of spontaneous resolution or resolution of CNLDO by conservative management in other studies were 94.6% (Price 1947), 89%: before 13 months (Petersen and Robb 1978), 94.7% (Nelson et al 1985), 89%: before16 months (Paul 1985), 93.3% (Nucci et al 1989), 96% (MacEven and Young 1991b), and 80% (Piest and Katowitz 1991). Noda and colleagues (1991) reported CNLDO in Japanese infants, all resolved with conserva- tive management by 9 months of age. Although the result in the present study showed a little lower rate than that of Table 1 Numbers of patients in whom CNLDO resolved by conservative management at each month of age and the possibility of resolution before 12 months of age (%) Months of age Numbers with Possibility of resolution resolution before 12 months of age (%) 1 0 82.9 2 1 82.4 3 4 80.0 4 1 79.3 5 4 76.0 6 6 68.4 7 1 66.7 8 1 64.7 9 3 57.1 10 5 33.3 11 2 14.2 12 1 – Clinical Ophthalmology 2008:2(2)