Monocanalicular silastic intubation for the initial correction of congenital nasolacrimal duct obstruction.

BACKGROUND: Treatment of persistent nasolacrimal duct (nasolacrimal duct obstruction) obstruction traditionally has consisted of simple probing. The most common complication with this approach has been recurrent obstruction, requiring another probing, often with the use of bicanalicular silastic intubation. Monocanalicular silastic tubing offers the possibility of increased success rates over simple probing while theoretically minimizing the insertion and removal difficulaties posed by bicanalicular techniques. We report, to our knowledge, the largest series to date of patients undergoing monocanalicular silastic intubation, as well as the first report evaluating this technique as the primary treatment for congenital nasolacrimal duct obstruction obstruction. METHODS: This was a retrospective chart review of 635 children treated by 3 pediatric ophthalmologists via probing with monocanalicular silastic intubation as the initial procedure for congenital nasolacrimal duct obstruction obstruction. Success was defined as good clearance of fluorescein dye and/or the absence of symptomatic tearing. Failure was defined as recurrent symptomatic tearing or inadequate clearance of fluorescein dye, leading to the performance of a second tear duct operation. RESULTS: We identified 635 children who underwent probing with monocanalicular intubation as the primary treatment for congenital nasolacrimal duct obstruction obstruction (mean age at time of probing 18 months). The overall success rate for the 803 eyes undergoing surgery was 96%. The success rate for treatment performed in infants younger than 24 months of age (684 eyes) was 97%, declining to 90% when surgery was performed in infants older than 24 months of age (119 eyes; p < 0.001). These success rates compare favorably to previous reports of primary probing without silastic intubation, especially in children older than 12 months at the time of the probing. The only complication in the current study was conjunctival-corneal abrasion, occurring in 2% of cases. CONCLUSIONS: Probing with monocanalicular silastic intubation as the initial surgical procedure for patients with congenital nasolacrimal duct obstruction obstruction is associated with a very high success rate and low complication rate, especially when performed by the age of 24 months.     

The round-tipped, eyed pigtail probe for canalicular intubation: a review of 228 patients

PURPOSE: To assess the effectiveness and outcomes of canalicular intubation with the use of a round-tipped, eyed pigtail probe. METHODS: Retrospective interventional case series of 228 patients requiring intubation of the canalicular system. Patients were treated surgically with attempted repair of the canalicular system with the round-tipped, eyed pigtail probe. The main outcome measures were successful intubation of the lacrimal system, symptoms of tearing, clinical functional evaluation of lacrimal system, complications, and need for further lacrimal surgery. RESULTS: Of 228 patients, 222 (97.4%) had their canalicular systems successfully intubated with silicone tubing using the round-tipped, eyed pigtail probe. Follow-up was obtained in 191 (86%) of the 222 patients. One-hundred sixty of 191 (83.8%) patients were irrigated and found to be anatomically patent (of the remainder, one was blocked whereas 30 were too young to be irrigated). One hundred fifty-two of the 191 (79.6%) patients had no tearing by history. Thirty-two (16.7%) had occasional tearing on some days that was not bothersome. Seven (3.7%) had intermittent or persistent tearing on a daily basis. Sixty-seven of the 191 (35%) had their lacrimal system more extensively assessed using the dye disappearance test, Jones I test, Jones II test, and canalicular probing. Anatomic patency in this subgroup was demonstrated in 66 of 67 (98.5%) of patients. The dye disappearance test, however, revealed slight asymmetry in 24 of 53 patients (45%) with canalicular lacerations yet only 14 of these 24 (58%) had any symptoms of tearing, indicating some discrepancy between subjective and objective assessment of tearing postcanalicular repair. Fifty-three of the repaired trauma patients underwent probing of the involved and uninvolved canalicular systems. In no patient was a stricture or blockage involving the uninvolved canaliculus identified. Additional lacrimal surgery (dacryocystorhinostomy) was performed on 2 of 191 (1%) patients with greater than 3 months follow-up. CONCLUSION: The round-tipped, eyed pigtail probe can help safely and effectively identify and repair canalicular lacerations. Symptomatic tearing was infrequent; the lacrimal systems showed complete anatomic patency in the majority of patients tested, and need for further lacrimal surgery was rare following pigtail probe intubation.     

Success Rates of Endoscopic-Assisted Probing Compared to Conventional Probing in Children 48 Months or Older

Background: To evaluate the success rates of endoscopic-assisted probing compared to conventional probing in children 48 months or older. Methods: This retrospective study included children 48 months and older with CNLDO who underwent endoscopic-assisted probing or conventional probing between January 2011 to August 2015 at a tertiary eye care hospital in central Saudi Arabia. Probing was considered successful when signals of tearing or discharge disappeared and fluorescein dye disappearance test (FDDT) was normal. Demographic data, clinical features, intraoperative and postoperative variables were correlated to the success rate. Results: One hundred and twelve children with CNLDO undergoing endoscopic-assisted (37 patients) or conventional (75 patients) probing were included. The success rates of endoscopic-assisted and conventional probing were 94.6% [95% confidence interval (CI): 89.5–99.7] and 58.7% [95% (CI): 47.6–69.8], respectively. The success rate was higher with endoscopic probing, especially in older children. Conclusions: Endoscopic-assisted probing can achieve better outcomes to treat CNLDO, even in older children. The significantly higher success rates with endoscopic probing are likely due to the ability to observe and treat associated problems.     

Comparison of monocanalicular stenting and balloon dacryoplasty in secondary treatment of congenital nasolacrimal duct obstruction after failed primary probing

PURPOSE: To determine the success of monocanalicular stenting and balloon dacryoplasty as secondary treatment options for congenital nasolacrimal duct obstruction after failed probing surgery. METHODS: An interventional case series of consecutive secondary balloon dacryoplasty and monocanalicular stenting for congenital nasolacrimal duct obstruction was reviewed. These secondary treatments were used in cases in which a bicanalicular stent would have been used in the past. Seventy-seven nasolacrimal systems in children with epiphora after probing and irrigation surgery were treated with a monocanalicular stent or balloon dacryoplasty. The patients were then evaluated at least 3 months after surgery or after stent removal by using a dye disappearance test. Cases in which there was no significant dye at 5 minutes were considered a success. Cases with residual dye or history of persistent tearing were considered failures. RESULTS: The monocanalicular stent was used in 35 nasolacrimal systems, whereas balloon dacryoplasty was used in 42 nasolacrimal ducts. The mean age of treatment was 25.2 months for the monocanalicular stent group and 25.8 months for the balloon group. Overall, 32 of 35 (91%) nasolacrimal ducts responded to monocanalicular stenting, whereas 36 of 42 (86%) responded to balloon treatment. When the patient group was further stratified by age, the monocanalicular stenting was 94% successful in children younger than age 2 years and 89% successful for children older than 2 years. The balloon treatment had a success rate of 91% in the younger group and 79% in the older group. Chi-square statistical analysis showed no significant difference between the two treatments or on the basis of age stratification within each treatment group. CONCLUSIONS: Monocanalicular stenting and balloon dacryoplasty are excellent secondary therapies for congenital nasolacrimal duct obstruction after initial probing and irrigation surgery has failed. These two treatment options are now our procedures of choice for secondary surgery.     

Outcome of late probing for congenital nasolacrimal duct obstruction in Singapore children

Objective: To evaluate the outcome of late probing in a mixed Asian children population with congenital nasolacrimal duct obstruction (CNLDO) and whether probing was associated with an increased risk of infection. Method: A retrospective clinical study was conducted. A clinical diagnosis of CNLDO was defined in an infant who presented with a history of tearing and/or eye discharge up to 1 year of age with no other accompanying ocular pathology. All patients with a presumed diagnosis of CNLDO who had probing after 12 months of age were included in our study. Prior to probing, most patients had a trial of conservative treatment with massage and/or topical antibiotics. Intra-operative patency of probing was determined when metal to metal contact of the probe and forceps was achieved and/or when fluorescein dye was recovered from the nose after syringing. Successful probing was defined as a resolution of symptoms within 1 month after probing. Results: Seventeen patients involving 19eyes fulfilled our inclusion criteria for this study. Fourteen (82%) infants were Chinese, two Malays (12%) and the remaining one Indian (6%). There were 10 males(59%) and 7 females(41%) and the mean age at probing was 2.2 years(range, 14 months to 5years 6 months). The subjects were followed-up post-operatively for a mean duration of 21.2 months (range, 2 months to 8years). Successful probing in our series was 89.5% (17/19 eyes). Of the two eyes with persistent tearing, one resolved with massage about 9 months after the unsuccessful probing; the other was referred to the oculoplastic service for further management. Conclusion: Late probing after 13 months old appears to be an effective approach in the management of CNLDO in Asian infants. This revised version was published online in August 2006 with corrections to the Cover Date.     

Spontaneous resolution in congenital nasolacrimal obstruction after 12 months

A retrospective observational study was performed in order to evaluate the possibility of spontaneous resolution of tearing in the congenital nasolacrimal obstruction (CNLO). Twenty-seven CNLO child carriers with spontaneous tearing resolution were evaluated according to sex, age of starting and end of symptoms. The data were evaluated by the Chi-Square Test and non-parametric Mann-Whitney test (p 相似文献   

Basisdiagnostik bei Tränenwegserkrankungen

The two main reasons for tearing are epiphora and excess lacrimation. Epiphora is a result of a failure of tear drainage caused by mechanical obstruction or lacrimal pump failure. Lacrimation is excessive tearing caused by reflex hypersecretion. The goal of the basic examination is to distinguish between epiphora and lacrimation. The clinical history, palpation, inspection, diagnostic probing and syringing are sufficient to evaluate the function of the lacrimal drainage system or to determine location and extension of obstructions in most patients with epiphora. Numerous diagnostic tests are available and the most important tests and their interpretation are described.     

Initial nasolacrimal duct probing in children under age 5: Cure rate and factors affecting success

AIMS: To evaluate the success rate of initial probing and the factors affecting the success rate for congenital nasolacrimal duct obstruction (CNLDO)in children under the age of 5 years. METHODS: In a prospective uncontrolled interventional case series, 207 eyes from 161 consecutive patients with CNLDO underwent nasolacrimal duct probing under brief general anesthesia. Based on exclusion criteria, 180 eyes from 139 patients were included in the study. Diagnoses were made according to the patients' histories, clinical examinations, and modified dye disappearance tests. The state of the punctum, the canaliculus, the sac, and the nasolacrimal duct were recorded. The main outcome measure was the complete disappearance of tearing and discharge in the affected eye. The patients were followed at 1 week, 1 month, and 3 months postoperatively. RESULTS: The age range was 5 to 60 months (mean, 19.1 +/- 11.2 months). The cure rates were 92% in the first year, 84.5% in the second year, 65% in the third year, and 63.5 in the fourth and fifth years of age. The patient's age, nonmemberanous CNLDO, and canalicular stenosis were correlated with the success of initial nasolacrimal duct probing (P <.05). CONCLUSIONS: Based on the results, simplicity of probing, and absence of significant complications, initial nasolacrimal duct probing is advised up to the age of 5 years. Increasing age, nonmembranous CNLDO, and canalicular stenosis increase the failure rate (P <.05).     

Dacryoscintigraphic Findings in the Children with Tearing

Purpose

To investigate the diagnostic effectiveness of dacryoscintigraphy in children with tearing; to evaluate tear clearance rate as a diagnostic factor of dacryoscintigraphy in children with tearing; and to analyze the results of treatment according to dacryoscintigraphic findings in children with tearing.

Methods

Between January 2010 and April 2014, 176 eyes of 88 children with tearing (49 boys and 39 girls; mean age, 23.81 ±14.67 months; range, 12 to 72 months) were studied retrospectively. Of these, 37 of 88 children with tearing were bilateral cases, and 51 were unilateral cases. None of the patients had a history of craniofacial disorder or trauma. The chief complaint of tearing with or without eye discharge and delivery mode, past history of neonatal conjunctivitis, syringing, or probing were collected from parents, grandparents, or previous hospital data. The drainage pattern of the nasolacrimal duct was analyzed, and the clearance rate of 50 µCi 99m technetium pertechnetate was measured by dacryoscintigraphy.

Results

According to the dacryoscintigraphy results, 98 of 125 eyes (78.4%) with tearing showed nasolacrimal obstruction and 29 of 51 eyes (56.9%) without tearing showed patency. There was a significant difference between tearing eyes and normal eyes (p = 0.001). The clearance rate difference after 3 and 30 minutes was 16.41 ± 15.37% in tearing eyes and 23.57 ±14.15% in normal eyes. There was a significant difference between epiphoric eyes and normal eyes (p = 0.05). Based on the dacryoscintigraphic findings, nasolacrimal-duct obstruction was treated with probing or silicone-tube intubation. The majority of patients showed symptom improvement (75.2%) during the two months of follow-up.

Conclusions

Dacryoscintigraphy is a non-invasive method of qualitatively and quantitatively diagnosing nasolacrimal duct obstruction in children with tearing.     

Bilateral congenital lacrimal fistulas in an adult as part of ectrodactyly-ectodermal dysplasia-clefting syndrome: A rare anomaly

Ectrodactyly-ectodermal dysplasia and clefting syndrome or “Lobster claw” deformity is a rare congenital anomaly that affects tissues of ectodermal and mesodermal origin. Nasolacrimal duct (NLD) obstruction with or without atresia of lacrimal passage is a common finding of such a syndrome. The authors report here even a rarer presentation of the syndrome which manifested as bilateral NLD obstruction and lacrimal fistula along with cleft lip and palate, syndactyly affecting all four limbs, mild mental retardation, otitis media, and sinusitis. Lacrimal duct obstruction and fistula were managed successfully with endoscopic dacryocystorhinostomy (DCR) which is a good alternative to lacrimal probing or open DCR in such a case.     

Endoscopic-guided trephination dacryocystorhinostomy (hesham DCR) : Technique and pilot trial

OBJECTIVES: (1) Test the feasibility and the safety of guided transnasal trephination in creating a nasolacrimal fistula. (2) Develop an appropriate lacrimal maintainer and test its value in modulating healing at the fistula site. DESIGN: Prospective, noncomparative interventional case series. PARTICIPANTS: Five cadavers and 19 patients. METHOD: A transcanalicular lacrimal probe penetrated the lacrimal fossa to guide the passage of a flexible trephine up the nose, which created the nasolacrimal communication. A special wide-caliber lacrimal maintainer was inserted along lacrimal tubes within the created passage. OUTCOME MEASURES: For cadaveric study, direct inspection after dissection of the facial flap was performed. For the clinical trial, subjective improvement in watery eye, dye testing, lacrimal probing, lacrimal irrigation, and endoscopic nasal examination. RESULTS: The technique resulted in the creation of a regular fistula of reproducible diameter into which a standard-shaped wide caliber maintainer could be inserted. Three months after removal of the maintainer and 6 months after surgery, a patent ostium was achieved in 17 of 18 (94%) patients who had a completed procedure. Relief of symptoms was achieved in 83%. CONCLUSIONS: Guided endoscopic dacryocystorhinostomy provides a simple and safe option for the treatment of nasolacrimal duct obstruction. The lacrimal maintainer is a useful device to achieve a large patent nasolacrimal communication.     

Dilation probing as primary treatment for congenital nasolacrimal duct obstruction

PURPOSE: Recent studies have suggested that simple nasolacrimal duct (NLD) probing can be an effective primary surgery for congenital NLD obstruction regardless of age. The success of balloon dilation after failed NLD probing suggests that maximally enlarging the passage through the NLD system may enhance the success of simple NLD probing. This study used sequential probing with modified, taper-tip probes to evaluate whether maximally enlarging the nasolacrimal duct can effectively treat congenital NLD obstructions in all age groups. METHODS: Under general anesthesia, each obstructed NLD system was sequentially probed with larger diameter NLD probes until firm resistance prevented the passage of any larger probe size. Successful treatment was defined as a negative dye-disappearance test 2 weeks after probing and the absence of tearing symptoms at last contact. RESULTS: A retrospective chart review identified 40 patients ages 6 to 32 months (average, 17.7 months) who underwent the sequential probing procedure. Sequential NLD probing was successful in 66 (92%) of 72 eyes. Of the failures, both eyes in a 15-month-old patient with Down's syndrome had tight, anomalous NLD systems. In the remaining 4 eyes, 2 had resolution of symptoms but partially positive dye-disappearance tests, and 2 underwent successful repeat sequential NLD probing. Subdividing by age, 27 (100%) of 27 obstructed NLD systems were treated successfully in patients older than 18 months compared with 39 (87%) of 45 in younger patients. CONCLUSIONS: Sequential NLD probing to maximally enlarge the NLD system has a high rate of success in all children. Age does not appear to have an impact on success of probing.     

Congenital lacrimal fistula associated with Down syndrome

Background

The aim of this work is to investigate the prevalence and clinical characteristics of congenital lacrimal fistula in Down syndrome patients.

Methods

The medical records of 198 Down syndrome patients who were referred to a tertiary ophthalmology clinic from 2000 to 2010 were retrospectively reviewed to identify patients with congenital lacrimal fistula. The demographic data, clinical features, clinical management, and clinical outcomes were recorded. The main outcome measures were the presence and laterality of fistula, accompanying adnexal and oculomotor abnormalities including congenital nasolacrimal duct obstruction (NLDO), the type of surgery performed, and surgical outcome. The prevalence of congenital lacrimal fistula in Down syndrome patients was calculated upon this data.

Results

Congenital lacrimal fistula was identified in 8/198 (4.04?%) patients, 4 (2.02?%) of whom presented with bilateral lacrimal fistula. All patients that had lacrimal fistula complained of tearing from their eyes. Congenital NLDO was observed in seven of eight patients with lacrimal fistula. Five patients underwent excision of the lacrimal fistula for the improvement of cosmesis, and three of these patients also underwent lacrimal silicone intubation for NLDO. Another patient received lacrimal silicone intubation for NLDO without excision of the lacrimal fistula. Excision of the lacrimal fistula was successful in all patients; however, tearing persisted after surgery in two patients with uncorrected NLDO.

Conclusions

Congenital lacrimal fistula occurs more frequently in Down syndrome patients and therefore these patients should be thoroughly examined for this abnormality. Down syndrome patients with congenital lacrimal fistula should be also examined for NLDO, because this condition is frequently observed in these patients.     

Endoscopic dacryocystorhinostomy in children.

BACKGROUND: Persistent nasolacrimal duct obstruction (NLDO) often requires treatment by probing, intubation, or balloon dacryoplasty. Refractory cases have been managed by external dacryocystorhinostomy (DCR), which leaves a scar; however, this procedure is generally avoided in young children. Endoscopic DCR has been successfully performed in adults and described in children. We report the success of this procedure in a series of pediatric patients. METHODS: A retrospective review of all endoscopic lacrimal procedures performed in a 3-year period was undertaken. Seventeen children (22 ducts) with persistent NLDO after at least one failed probing, with or without silicone tube placement, underwent endoscopic DCR. Follow-up ranged from 6 to 36 months, and success was defined as resolution of tearing and discharge by follow-up clinical evaluation and by parental history. RESULTS: All but 2 patients (88%) with NLDO showed complete resolution of tearing and discharge. These 2 patients had recurrent symptoms after the Crawford tubes were removed and required revision endoscopic DCR. No complications from this procedure were noted. CONCLUSIONS: Endoscopic DCR is a safe and effective means of treating persistent NLDO in infants and young children when simple probing, intubation, or balloon procedures have failed. The team ophthalmology-otolaryngology endoscopic approach provides a highly successful alternative for patients with a persistent distal obstruction that might otherwise require an external procedure.     

Bloody tears of unknown cause: case series and review of the literature

PURPOSE: To report 4 cases of recurrent unilateral bloody tears. METHODS: Retrospective case series. RESULTS: One boy and 3 girls, ranging in age from 6 to 14 years, reported spontaneous bloody tearing. Workup included probing and irrigation of the nasolacrimal system, blood and coagulation profiles, blood typing, serum hormone levels, conjunctival biopsy, and imaging. All findings were normal and failed to suggest a cause in any of the cases. In all patients, bloody tearing eventually resolved without further sequela. No recurrence has been reported over a follow-up period of 9 months to 11 years. CONCLUSIONS: Bloody tearing is an unusual clinical entity that concerns patients and can perplex physicians. A thorough examination and proper workup are necessary to rule out serious conditions but may fail to determine a cause. These idiopathic cases typically resolve without treatment.     

Unusual reaction to fluorescein dye in patients with inflammatory eye disease

PURPOSE: Ocular side effects attributable to intravenous fluorescein dye are not well characterized. The purpose of this report was to describe three patients with an unusual ocular reaction after the intravenous administration of fluorescein dye. METHODS: Retrospective review of the clinical and photographic records of three patients. RESULTS: Each patient had some type of preexisting ocular inflammatory disease. Each patient described the subacute onset of a unilateral burning sensation and tearing several minutes after the administration of intravenous fluorescein dye. Findings included a new onset of or a worsening of unilateral conjunctival chemosis and injection in all three patients and yellowish discoloration of the conjunctiva in two patients. In each patient, the noninflamed (fellow) eye did not develop any symptoms or show any visible reaction. The symptoms and findings resolved promptly in the affected eye without specific treatment or effect on vision. CONCLUSIONS: Ocular side effects of intravenous fluorescein dye can include transient symptomatic burning and tearing associated with conjunctival chemosis, injection, and yellowish discoloration. Eyes with active inflammatory diseases may be predisposed to this rare effect through an unclear mechanism.     

Monocanalicular lesions: to reconstruct or not.

OBJECTIVE: To evaluate the success rate of a simple surgical method for the treatment of a monocanalicular lacrimal lesion. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Thirteen consecutive patients with monocanalicular trauma who were seen from August 1995 to March 1998. In six patients, the canaliculus was lacerated as a result of an external injury and in seven patients as a result of tumor removal (iatrogenic injury). INTERVENTION: Reapproximation of the orbicularis muscle and skin overlying the torn canaliculus without reanastomosis of the lacerated canaliculus. In those patients in whom the canaliculus was sacrificed as part of the removal of an eyelid tumor, no attempt was made to reconstruct the canaliculus. MAIN OUTCOME MEASURES: Symptomatology, patency of the lacrimal passage, fluorescein dye disappearance test, and patient satisfaction. RESULTS: In all patients the injured canaliculus was totally blocked, but despite this none of the patients complained of inconvenient tearing either indoors or outdoors. The ipsilateral unharmed canaliculus was functioning normally in such a way that the fluorescein dye instillation test showed residual dye in six patients after 2 minutes and in none of the patients after 5 minutes. All patients were satisfied with the functional and cosmetic result. CONCLUSION: Nonrepair of a monocanalicular lesion is a valid approach that results in little or no morbidity.     

Epiphora as a side effect of topical mitomycin C

AIM: To report symptoms and findings of lacrimal duct malfunction after topical mitomycin C (MMC) for conjunctival neoplasia. METHODS: 14 consecutive patients treated with 1-6 cycles of topical 0.04% MMC four times daily for periods of 2 weeks were interviewed about symptoms of lacrimal duct malfunction. Patients who complained of tearing had examination of the puncta and canaliculi including probing and lacrimal duct irrigation. RESULTS: Nine patients complained of epiphora after topical MMC. Three of these patients had normal puncta and canaliculi, patent to irrigation. In these patients epiphora ceased spontaneously after probing and irrigation. The additional six patients had stenosis of the punctum (n = 3), the common canaliculus (n = 1), both puncta and both canaliculi (n = 1) and complete occlusion of the lower canaliculus (n = 1). CONCLUSION: Obstruction of the puncta or canaliculi is not an infrequent event after topical 0.04% MMC.     

Inferior turbinate fracture and congenital nasolacrimal duct obstruction

PURPOSE: To evaluate the success rate of probing combined with inferior turbinate fracture in comparison with simple probing as a first attempt in the treatment of congenital nasolacrimal duct obstruction in children. METHODS: In a prospective interventional case-control study, 86 eyes from 61 children older than 6 months with congenital nasolacrimal duct obstruction underwent surgical intervention. Forty-two eyes of 33 patients underwent probing combined with infracturing of the inferior turbinate and 44 eyes of 28 patients underwent simple probing. The outcome evaluation included a standard ophthalmologic examination plus a dye disappearance test 2 months after the surgical intervention. RESULTS: In the case group (probing + infracture of the inferior turbinate), the results were good in 22 (66.7%) patients, fair in 8 (24.2%), and poor in 3 (9.1%). In the control group (simple probing), the results were good in 20 (71.4%) patients, fair in 3 (10.7%), and poor in 5 (17.9%) (p=0.9). Success rates were 91% and 82% in the case and control groups, respectively (p=0.4). CONCLUSIONS: Based on the results of this study, infracturing of the inferior turbinate does not increase the success rate of simple probing as a first attempt.     

Timing of initial probing and irrigation in congenital nasolacrimal duct obstruction

A series of 427 patients with congenital dacryostenosis involving 572 eyes was seen at the Children's Hospital of Philadelphia. All patients were treated conservatively with antibiotics and massage prior to decision by the parents to request probing. Congenital dacryostenosis, as well as resolution of symptoms, were confirmed by clinical examination and use of a modified dye disappearance test. In 572 eyes, the success rate of initial probing was found to be 97% under 13 months of age. Over 13 months, however, the mean success rate was found to be 54.7%. When broken down into smaller age categories, a stepwise progression was observed from 76.4% between 13 and 18 months to 33.3% for patients probed after 24 months. In addition, the number and complexity of subsequent procedures appeared to increase along with the age at which the initial probing was performed. These data suggest that initial probing should be done prior to 13 months of age depending on the severity of symptoms and parent compliance with medical management.