Medical management of congenital nasolacrimal duct obstruction

Fifty-five infants were diagnosed to have nasolacrimal duct obstruction by an ophthalmologist prior to three months of age. All were followed prospectively, primarily with medical management. Seven were treated surgically. In the 55 infants, there were 62 obstructed nasolacrimal ducts. Eighty-nine percent (55/62) of the nasolacrimal ducts were opened with medical management only in the first sixteen months of life. Of the nasolacrimal ducts that opened spontaneously, 15% (8/55) were open at three months, 45% (25/55) were open at six months, 71% (39/55) were open at nine months, and 93% (51/55) were open at one year. Based on this data one can advise the parents of infants with nasolacrimal duction what the odds of remission are without surgery by the twelfth month of age. Of the infants obstructed at three months of age, 80% were clear by the twelfth month. Of the infants obstructed at six months, 70% were clear by the twelfth month and of those still obstructed at nine months, 52% were clear by the twelfth month.     

Medical management of congenital nasolacrimal duct obstruction

A consecutive series of 113 infants seen with congenital nasolacrimal duct obstruction were treated with local massage and topical antibiotic ointment. In 107 of the infants the obstruction was resolved within 8 months of initiation of this form of management. Nearly all of the infants were spared a surgical procedure that probably would have been performed if early probing of the nasolacrimal system had been advocated.     

Follow-up after probing for congenital nasolacrimal duct obstruction

PURPOSE: To establish the optimum timing of follow-up after probing for uncomplicated congenital nasolacrimal duct obstruction. METHODS: A retrospective review of notes of all patients probed over a 4-year period was performed. Timing of symptom resolution was evaluated and compared to the results of a questionnaire sent to all parents in June 1996. RESULTS: Most patients were asymptomatic or improved by 3 months postoperatively, and the long-term success rate was 96.6%. CONCLUSION: Optimum timing of follow-up should be 3 months postoperatively, if necessary at all.     

Congenital nasolacrimal duct obstruction: therapeutic management

PURPOSE: Congenital nasolacrimal duct obstruction is a common condition, and its diagnosis must be based more on regular in-time epiphora than mattering. The purpose of this study is to better define the diagnostic criteria and therapeutic strategy. METHODS: We have retrospectively evaluated 1563 subjects treated from 1990-1997 at the Pediatric Ophthalmological Service of Modena University Eye Clinic. The mean age at first examination was 5.7 months. According to symptoms and age, patients were treated with antibiotic therapy, office probing, or general anesthesia probing. Recovery was confirmed only after a 3-month symptom-free period. RESULTS: More than 29% of patients recovered spontaneously or with topical antibiotic therapy. Office probing reduced the number of patients who needed a general anesthesia probing (from 62.97% from 1990-1993 to 33.61% from 1994-1997). In the period from 1994-1997, we changed the technique and especially the age of patients, obtaining a clearing of the obstruction in about 86% of cases compared with a 39% rate in the earlier period. Since 1994, in cases of general anesthesia probing, we have used a midazolam and ketamine anesthesiologic technique that has reduced risks and increased parental satisfaction and cost-effectiveness. Also, our data show that age at first attempt highly influenced probing failure rate. CONCLUSION: If the first ophthalmologic examination is precocious and correctly timed, the possibility of curing the patient using the simplest method is increased. Better results can be obtained with cooperation among pediatricians, ophthalmologists, and anesthesiologists.     

Antibiotic therapy in congenital obstruction of the nasolacrimal duct

Forty-eight children aged from 4 to 11 months, affected by Congenital Nasolacrimal Duct Obstruction (CNDO), treated successfully by local hydrostatic massage, were retrospectively included in two groups: Group A treated by massage and antibiotic eye drops, Group B treated by massage only. The comparison shows a quicker resolution of the CNDO when antibiotic eye drops are administered. The Author stresses the utility of topical antibiotic therapy regardless of the presence of mucopurulent discharge.     

Success rate and cause of failure for late probing for congenital nasolacrimal duct obstruction

PURPOSE: To evaluate the outcome of late probing for congenital nasolacrimal duct obstruction in children 2 to 6 years old and to identify the cause of failure in these children. METHODS: Records of 65 nasolacrimal duct obstructions in 62 children (39 boys and 23 girls) aged 2 to 6 years who underwent primary probing for congenital nasolacrimal duct obstructions were evaluated. The main observations were the type of obstruction encountered during probing (complex/simple), age at the time of probing, and success rate depending on the type of obstruction. Success was the main outcome measure and was defined as complete resolution of all signs and symptoms at 1 week of follow-up. The Mann-Whitney test for statistical significance was used to compare the results between simple and complex nasolacrimal duct obstructions. RESULTS: Six children had bilateral obstruction. The average age at the time of probing was 37.71 months in children with complex obstruction and 37.27 months in children with simple obstruction. Twenty-one eyes (32.20%) had complex obstruction and 44 eyes (67.69%) had simple obstruction. The success rate was 33% in children with complex obstruction and 97.72% in children with simple obstruction, which was statically significant. The overall success rate of the whole cohort was 76.92%. CONCLUSION: Older children with simple obstruction undergoing late probing had an excellent success rate in this study (97.72%). Complex obstruction is the main risk factor for failure of probing in older children. Probing is a successful and viable option in older children.     

A controlled study of silver nitrate prophylaxis and the incidence of nasolacrimal duct obstruction

The caustic property of silver nitrate prompted a double-blind, controlled study of a possible causal relationship between use of the agent for prophylaxis against ophthalmic infection in the newborn and the subsequent development of nasolacrimal duct obstruction. Follow-up of 145 newborns randomized either to 1% silver nitrate prophylaxis or to 1% tetracycline prophylaxis revealed no statistically significant difference in the incidence of nasolacrimal duct obstruction between the two groups at either two weeks or two months of age. It is concluded that silver nitrate prophylaxis does not predispose to nasolacrimal duct obstruction in the newborn.     

Intranasal mucocele of the nasolacrimal duct: an important cause of neonatal nasal obstruction

Anterior nasal obstruction secondary to cystic or solid masses is believed to be uncommon. Previous single or series case reports of intranasal mucoceles of the nasolacrimal duct have been published in otolaryngology, ophthalmology, or radiology journals but were not found in general pediatric journals. A 5-year retrospective chart review from our children's hospital found 10 previously unreported cases of intranasal mucocele of the lacrimal duct causing neonatal nasal obstruction. The purpose of this report is to familiarize pediatricians with this entity, which was the most common cause of anatomic anterior nasal obstruction at our hospital.     

Congenital nasolacrimal duct obstruction in Japanese infants: its incidence and treatment with massage

We examined the patency of 670 nasolacrimal ducts in 335 newborn infants--42 patients (62 ducts) had obstructions; the involvement was unilateral in 22 and bilateral in 20. No sexual predilection was noted. All affected patients were treated with hydrostatic massage at the area of the lacrimal sac. About two-thirds of the ducts became patent by 2 months after birth, while the remainder became patent by 9 months. Only one patient who had acute dacryocystitis at age 5 months required a probing of the duct and a regimen of systemic antibiotics to achieve good results.     

Unilateral congenital nasolacrimal mucocele

A case of a congenital nasolacrimal mucocele is reported. This very uncommon finding presents usually with a diagnostic triad on CT: an intranasal cystic mass, a dilated nasolacrimal duct and lacrimal sac.     

Probing for nasolacrimal duct obstruction using intranasal midazolam sedation as an alternative to general anesthesia

OBJECTIVE: To investigate the effectiveness of topical anesthesia with sedation using intranasal midazolam in patients with symptomatic congenital nasolacrimal duct obstruction undergoing probing. PATIENTS AND METHODS: In this prospective study, probing was performed with general anesthesia (30 cases) and with topical anesthesia using intranasal midazolam (0.3 mg/kg; 44 cases) in 74 patients who were divided into two groups, those 6 to 36 months old and those older than 36 months. The groups were compared after 12 to 48 months (mean, 18.2 months). RESULTS: For the patients 6 to 36 months old, the success rate was 80% in the group who received general anesthesia and 88.9% in the group who received topical anesthesia with intranasal midazolam; the difference between the two groups was not statistically significant (P > .05). For the patients older than 36 months, the success rate was 20% in the group who received general anesthesia and 25% in the group who received topical anesthesia with intranasal midazolam; there was no statistically significant difference between the two groups (P > .05). CONCLUSIONS: Probing with topical anesthesia in the office setting is usually recommended for patients younger than 8 months. Our results show that this is suitable for children until 4 years of age with the support of intranasal midazolam sedation. Probing under topical anesthesia with intranasal midazolam is cost-effective, safe, and comparable in efficacy to probing under general anesthesia but with less risk.