Patient presents with symptoms consistent with nasolacrimal duct obstruction (NLDO).  Chief complaints include epiphora, excessive tearing, mucopurulent discharge, and mattering of the eyelashes, particularly upon awakening.  Symptoms may be unilateral or bilateral.  Onset of symptoms was [duration] and [frequency - e.g., constant, intermittent].  Patient reports [associated symptoms, e.g., eyelid crusting, redness, swelling, pain, blurred vision] or denies any associated symptoms.  Physical examination revealed [positive findings e.g., presence of mucopurulent discharge at the puncta upon palpation of the lacrimal sac, positive Jones I or Jones II test result] or [negative findings, e.g., absence of erythema or edema].  Differential diagnoses considered include conjunctivitis, dacryocystitis, and other causes of epiphora.  Assessment: Nasolacrimal duct obstruction.  Treatment plan includes [conservative management options e.g., warm compresses, lacrimal sac massage, topical antibiotics if secondary infection present] or [surgical intervention e.g., probing, dacryocystorhinostomy (DCR) if conservative management fails]. Patient education provided on proper hygiene and follow-up care.  Follow-up appointment scheduled in [timeframe] to assess response to treatment.  ICD-10 code H04.52 (acquired nasolacrimal duct obstruction) or H04.42 (congenital nasolacrimal duct obstruction) if applicable.  CPT codes for procedures performed to be documented separately.