Outcome of probing for congenital nasolacrimal duct obstruction in older children

• Published in: American journal of ophthalmology Vol. 130; no. 1; pp. 42 - 48
• Main Authors: Honavar, Santosh G, Prakash, Vasudha E, Rao, Gullapalli N
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-07-2000; Elsevier
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Dacryocystorhinostomy - methods; Female; Fluorophotometry; Humans; Lacrimal Duct Obstruction - congenital; Lacrimal Duct Obstruction - diagnosis; Male; Medical sciences; Nasolacrimal Duct - pathology; Nasolacrimal Duct - surgery; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Tears - metabolism; Treatment Outcome; Human; Nose disease; Prognosis; Congenital; Treatment efficiency; Nasolacrimal duct; Infant; Probe; Lacrimal apparatus disease; Congenital disease; Obstruction; Eye disease; Treatment; Surgery; ENT disease
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/S0002-9394(00)00388-3

PURPOSE: To evaluate the role of probing in congenital nasolacrimal duct obstruction in children age 2 years and older and to establish factors predictive of the outcome.
METHODS: The study was a single-center, prospective, interventional case series. Sixty patients with congenital nasolacrimal duct obstruction aged 24 months or older (range, 24 to 186 months; median, 33 months) presenting consecutively to the authors’ institutional referral practice were studied. Probing of the nasolacrimal system under general anesthesia was the surgical intervention. Success of probing was the main outcome measure. Success was predefined as complete resolution of symptoms and signs (tearing, crusting, discharge, regurgitation on pressure over the lacrimal sac) of congenital nasolacrimal duct obstruction within 3 weeks of the procedure and continued remission at 6 months. Two attempts at probing were necessary before the procedure was declared a failure.
RESULTS: One attempt at probing resulted in resolution in 73.3% (44 of 60) patients. Sixteen patients needed a repeat procedure. The overall success rate was 80% (48 of 60). Two specific types of obstructions of the nasolacrimal duct were recognized on probing: membranous and firm. Factors predictive of failure of probing were age older than 36 months (
P < .0001); bilateral affection (
P = .012); failed conservative therapy (
P = .015); failed earlier probing (
P < .0001); dilated lacrimal sac (
P < .0001); and firm obstruction (
P < .0001).
CONCLUSION: Results indicate that probing is a viable primary surgical option for congenital nasolacrimal duct obstruction in children who present between 2 and 3 years of age, and identify factors predictive of poor prognosis.