Final answer:
The most probable treatment for a 40-year-old male presenting with epiphora and positive lacrimal syringing test indicating blockage is dacryocystorhinostomy. This surgical procedure creates a new channel for tear drainage to bypass the obstructed nasolacrimal duct.
Step-by-step explanation:
If a 40-year-old male presents with epiphora (excessive tearing) and on lacrimal syringing from the lower punctum, saline comes out from the upper punctum, the most probable treatment is 1) Dacryocystorhinostomy. This indicates a potential blockage in the nasolacrimal duct, which can cause a condition known as dacryocystitis, an inflammation of the lacrimal sac. The condition often arises from a plugged nasolacrimal duct. Dacryocystorhinostomy is a surgical procedure to create a new channel between the lacrimal sac and the nose to bypass the blockage in the nasolacrimal duct.
The options of nasolacrimal duct probing and syringing, antibiotics, and topical steroid drops are typically considered when there is a less severe blockage or when inflammation without significant obstruction is present. In the given scenario where lacrimal syringing already indicates a duct obstruction, dacryocystorhinostomy is the definitive treatment.