Endoscopic-assisted probing for congenital nasolacrimal duct obstruction

PURPOSE: To determine the success rate of initial probing in children with congenital nasolacrimal duct obstruction (CNLDO) at different ages using nasal endoscopy, and to identify the anatomical sites of blockage within the drainage system. METHODS: A total of 87 eyes from 67 consecutive children with CNLDO underwent endoscopic nasolacrimal duct (NLD) probing under general anaesthetic. Patients who had had previous probings were excluded from the study. Diagnosis was based on history of epiphora since birth or shortly after, and fluorescein dye disappearance test (FDDT). Cure was judged as complete or near-complete remission of symptoms and signs and a normal FDDT. RESULTS: The age range was 12-91 months (mean 32.3 months). The success rates of probing were: 100% (58/58) for atresia and stenosis at the lower NLD, 100% (13/13) for punctal stenosis, 55.6% (5/9) for functional epiphora, and 0% (0/7) for canalicular and upper NLD obstruction. Age was not found to significantly affect the outcome of probing, whereas site did. Obstruction at canalicular or upper NLD level became more common with increasing age. CONCLUSION: Probing of the nasolacrimal system using the endoscopic approach allows direct visualisation of the distal nasolacrimal duct, which facilitates diagnosis of the anomaly at this site. More complex proximal anomalies became increasingly prevalent in older children, which accounted for the poorer results with increasing age. Site of obstruction has a greater bearing on outcome than patient age.     

Curative effects of probing alone and probing combined with nasolacrimal injection of levofloxacin ophthalmic gel on congenital duct obstruction of children from 3-12 months of age

Background: To investigate the 1-time success rate of probing alone and nasolacrimal duct probing combined with nasolacrimal injection of levofloxacin ophthalmic gel on congenital nasolacrimal duct obstruction (CNLDO) in young children. Methods: A retrospective case series was performed on 494 cases (647 eyes) of 3–12 month-old children with CNLDO between July 2014 and July 2015. Material obtained from the lacrimal sac was cultured to isolate infectious agents. Susceptibility testing was done. Children from 3–12 months of age who were found to be sensitive to Levofloxacin (n=493 eyes) were separated into two groups: 3–6 months of age (276 eyes) and 7–12 months of age (217 eyes). Each of the groups were then randomized into group A (138 eyes of 3–6 months of age; 102 eyes of 7–12 months of age) and group B (138 eyes of 3–6 months of age; 115 eyes of 7–12 months of age). Children in group A underwent nasolacrimal duct probing alone; those in group B underwent nasolacrimal duct probing plus nasolacrimal duct injection of levofloxacin and the efficacy of probing was evaluated. Results: The average detection rate of pathogenic bacteria in dacryocystitis was 75.1%, andStaphylococcus aureuswas found to be the main pathogenic bacteria (42.59%, 106 cases). Among children from 7–12 months of age, the 1-time success rate of nasolacrimal duct probing alone was 88.24% and the 1-time success rate of probing combined with nasolacrimal duct injection of levolfoxacin ophthalmic gel was 96.52% (statistical signiifcance, P=0.02<0.05). Conclusions: Most pathogenic bacteria (96.81%) were sensitive to levofloxacin. Nasolacrimal duct probing combined with nasolacrimal duct injection of levolfoxacin may improve the success rate of probing in children older than 6 months of age.     

Late and very late initial probing for congenital nasolacrimal duct obstruction: what is the cause of failure?

AIMS: To find the cure rate of late (second year of age) and very late (3-5 years of age) initial probing for congenital nasolacrimal duct obstruction (CNLDO) and to identify the factors contributing to the failure rate of the probing in older children. METHODS: In a prospective interventional case series study, 169 eyes of 125 consecutive patients (1-5 years old) with CNLDO underwent probing under general anaesthesia. Cure was defined as absence of tearing and discharge in the affected eye. RESULTS: 138 eyes of 101 patients aged 13-60 months (mean 23.4 (SD 10.2)) were included. Of 15 eyes (10.8%) with complex CNLDO, 80% presented after 24 months of age (p<0.0001). The cure rate was 89% in patients 13-24 months of age and 72% after the age of 24 months (p = 0.01). It was 90.2% in the membranous and 33.3% in the complex CNLDO in both late and very late probing (p<0.0001). There was a high correlation (r = 0.97) and no significant difference between the cure rate at 1 week and final follow up. CONCLUSION: Accumulation of the complex CNLDO is the main risk factor for failure of probing in the older children. The outcome of the nasolacrimal duct probing at 1 week follow up is highly indicative of the final outcome.     

先天性鼻泪管阻塞治疗探讨

目的 探讨先天性鼻泪管阻塞的不同治疗方法和治疗时机.方法 回顾分析了735例837只眼在复旦大学附属儿科医院诊断为先天性鼻泪管阻塞的患儿,平均首诊年龄4.5月.根据首诊年龄和症状分别采用保守治疗、加压泪道冲洗法和泪道探通法,经随访3～16月,平均6.4月.以溢泪症状完全消失作为治愈指标.结果 保守治疗的有效率为14.7%;加压泪道冲洗法的有效率为25.4%;泪道探通法的有效率为97.2%;15只眼未愈.早期探通(<6月龄组)1次成功率为87.7%;后期探通(>7月龄组)1次成功率为56.6%.结论 泪道探通法治疗先天性鼻泪管阻寒安全有效,最佳干预时机为4～6月龄.     

早期泪道探通术治疗先天性鼻泪管阻塞的疗效观察

目的 探讨先天性鼻泪管阻塞(congenital nasolacrimal duct obstruction,CNLDO)的最佳治疗时机,阻塞部位的不同对探通术成功率的影响,以及重复探通术的成功率.方法 对804例(976只眼)1～48个月CNLDO患儿行表面麻醉下泪道探通术,按不同年龄组、不同阻塞部位和重复探通术的疗效进行回顾性分析.结果 经过治疗治愈958只眼,总治愈率为98.2%.不同年龄组探通成功率差异有统计学意义(x2=163.9,P<0.005),其中1～3个月婴儿的成功率为98.5%,高于其他年龄组.66只眼接受二、三次探通术,主要是鼻泪管多处阻塞者,占84.8%.一次探通的治愈率与二、三次探通的治愈率差异有统计学意义(x2=186.0,P<0.005);二次探通与三次探通比较,差异无统计学意义(x2=0.18,P>0.025).结论 CNLDO患儿选择早期泪道探通的最佳治疗时机是1～3个月,鼻泪管多处阻塞患儿重复探通率高,2～3次探通不成功者应尽早采用其他方法进行治疗.     

Clinical outcomes of initial and repeated nasolacrimal duct office-based probing for congenital nasolacrimal duct obstruction

Purpose

To characterize the outcomes of initial and repeated office-based probing as a primary treatment for congenital nasolacrimal duct obstruction (CNLDO) in children.

Methods

The medical records of patients who underwent nasolacrimal duct office-based probing for CNLDO between March 2004 and January 2008 were reviewed retrospectively. Nasolacrimal duct probing was performed on 244 eyes from 229 consecutive patients with CNLDO. Patients who were refractory to the first probing underwent a second probing 4 to 8 weeks later.

Results

Based on exclusion criteria, 244 eyes from 229 patients (117 males and 112 females), aged 6 to 71 months (mean, 12.4 ± 8.36) were included. The success rate of the initial probing was 80% (196 of 244) for all patients, 82% (111 of 136) in the 6 to 12 month age group, 79% (64 of 81) in the 13 to 18 months age group, and 78% (21 of 27) among individuals older than 19 months (p = 0.868, Pearson chi-square test). The success rate of the second probing was 61% (25 of 41) for all patients, 74% (17 of 23) in the 6 to 12 months age group, 58% (7 of 12) in the 13 to 18 months age group, and 17% (1 of 6) among individuals older than 19 months (p = 0.043, Fisher''s exact test).

Conclusions

While the success rate of initial nasolacrimal duct probing is not affected by age, the rate of success rate with a second probing was significantly lower in patients older than 19 months. Based on the results, authors recommend further surgical interventions, such as silicone tube intubation or balloon dacryocystoplasty, instead of repeated office probing for patients older than 19 months, if an initial office probing has failed.     

Comparison of balloon dacryocystoplasty to probing as the primary treatment of congenital nasolacrimal duct obstruction.

PURPOSE: In children older than 18 months, primary probing procedures for congenital nasolacrimal duct obstruction (CNLDO) are thought to have lower rates of success. This study compares the results of primary probing to balloon dacryocystoplasty (DCP) in children stratified by age category. METHODS: In a retrospective chart review, 29 eyes with CNLDO that underwent balloon DCP in children older than 18 months were identified and age-matched to 29 eyes that underwent probing. The eyes were divided into 3 age categories: category 1 (18-24 months), category 2 (24-36 months), and category 3 (>36 months). RESULTS: Of the 29 eyes treated with balloon DCP (mean age, 37.1 months), 26 were successfully treated. Twenty-five of the 29 matched probed eyes (mean age, 31.1 months) were successfully treated, resulting in an overall success rate of 90% for balloon DCP and 86% for primary probing. Within each age category, the success rate varied but did not show an advantage to balloon DCP. The presence of crusting and expressible discharge from the puncta during preoperative evaluation predicted a successful probing (OR, 16; 95% CI, 1.3-192). CONCLUSION: Overall, balloon DCP did not appear to present an advantage as compared with primary probing as the initial treatment in these children. Primary probing has an impressive overall success rate that did not diminish in the children older than 36 months.     

Pushed monocanalicular intubation versus probing for the treatment of simple and incomplete complex types of congenital nasolacrimal duct obstruction in children older than 18 months old

This article compares the success rate of pushed monocanalicular intubation (Masterka) versus probing for the treatment of congenital nasolacrimal duct obstruction (CNLDO) in children older than 18 months. In a non-random comparative study, 90 eyes with CNLDO underwent either Masterka (45 eyes) or probing (45 eyes). All procedures were performed by one oculoplastic surgeon. The tubes were removed 2 months after the operation. Complete resolution was defined as complete absence of clinical signs and symptoms of CNLDO at 6 months after the procedure. The mean age at the time of treatment was 28 ± 18.2 months for Masterka and 26.7 ± 18.6 months for probing group. Treatment success was achieved in 33 of 45 eyes (73.3%) in the Masterka group compared with 22 of 45 eyes (48.9%) in the probing group. The difference between the two groups was statistically significant (p = 0.017). For the treatment of CNLDO, Masterka might be more effective than probing in children older than 18 months.     

A comparison of the success rates of endoscopic-assisted probing in the treatment of membranous congenital nasolacrimal duct obstruction between younger and older children and its correlation with the thickness of the membrane at the Valve of Hasner

Congenital nasolacrimal duct obstruction (CNLDO) remains the most common cause of epiphora in infants. This retrospective study compares the success rate of nasal endoscopic-assisted probing between younger (3 years and below) and older (above 3 years) children with membranous CNLDO and its correlation with the thickness of the membrane at the valve of Hasner. Case records of a total of 38 eyes in 34 children with membranous CNLDO who underwent endoscopic nasolacrimal duct probing and irrigation under general anesthesia were analyzed. The cases were divided into two groups, Group Y (20 cases of children 3 years and below) and Group O (18 cases of children above 3 years). The success of the procedure was defined as complete remission of symptoms and a clinical examination of eye to rule out the presence for discharge or watering after three months of the procedure. Overall, 35 cases (92.1%) were successfully treated with a success rate of 95% in Group Y and 88.9% in Group O. The mid-P exact test p value for the success rate between the two cohorts was not statistically significant (p = 0.59). The thick membrane was observed in 50% cases in Group Y and 33.33% cases in Group O (p = 0.34). There is no age related decline in the overall success rate for nasal endoscopic-assisted probing and irrigation in cases of membranous CNLDO. The thickness of the membrane may be a factor for failed blind probing, but it has no correlation with the success rate if probing is done under endoscopic guidance.     

Monocanalicular versus bicanalicular silicone intubation for nasolacrimal duct stenosis in adults

PURPOSE: To compare the success rate of monocanalicular versus bicanalicular silicone intubation of incomplete nasolacrimal duct obstruction (nasolacrimal duct stenosis) in adults. METHODS: In a retrospective, nonrandomized comparative case series, 48 eyes of 44 adult patients with nasolacrimal duct stenosis underwent endoscopic probing and either bicanalicular (BCI; n=22 eyes) or monocanalicular (MCI; n=26 eyes) nasolacrimal duct intubation under general anesthesia. "Complete success" was defined as complete disappearance of the symptoms, "partial success" as improvement with some residual symptoms, and "failure" as absence of improvement or worsening of symptoms at last follow-up. The last follow-up examination included diagnostic probing and irrigation if there was not complete success. RESULTS: Patient ages ranged from 31 to 90 years (mean, 69; SD, 11.5). Forty-five tubes were removed 6 to 17 weeks (mean, 9.1; SD, 3) after surgery. Premature tube dislocation and removal occurred in one eye with BCI and in two eyes with MCI. Follow-up ranged from 6 to 52 months (mean, 14.9; SD, 8.4). The complete success rate was nearly the same in eyes with MCI (16/26, 61.53%) and BCI (13/22, 59.09%). Partial success (MCI: 8/26, 30.76%; BCI: 1/22, 4.54%) and failure (MCI: 2/26, 7.69%; BCI: 8/22, 36.36%) were, however, significantly different (p=0.010). Complications included 3 slit puncta with BCI and 4 temporary superficial punctuate keratopathy after MCI. CONCLUSIONS: MCI had virtually the same complete success rate as BCI, a higher partial success rate than BCI, and a lower failure rate than BCI in treatment of nasolacrimal duct stenosis in adults.     

先天性鼻泪管阻塞伴泪小管阻塞的泪道探通术

目的探讨先天性鼻泪管阻塞合并泪小管阻塞的患儿泪道探通术的效果。方法此病患儿27例（29眼）作为研究组,单纯鼻泪管阻塞23例（30眼）作为对照组。两组均行常规的泪道探通术,应用荧光染料消失试验（FDDT）及泪道冲洗方法,观察治疗效果。结果研究组中合并下泪小管阻塞13例（14眼）,合并上泪小管阻塞者14例（15眼）,成功疏通鼻泪管阻塞26眼,治愈率89．7％;对照组30眼治愈27眼,（治愈率90．0％）,两组之间比较差异无统计学意义,χ2=0．002,P=0．965。成功疏通泪小管者在29眼中仅有11眼,占37．9％。术后FDDT比较,伴有泪小管阻塞组FD—DT0级小于对照组,FDDT1-2级大于对照组,χ2=7．096,P=0．029。鼻泪管探通成功但泪小管探通失败,仅存单个正常泪小管的17眼,仅存的上或下泪小管一部分能够起到有效的引流泪液的功能（上泪小管阻塞FDDT0级4眼,FDDT1级6眼,FDDT2级1眼,下泪小管阻塞FDDT0级1眼,FDDT1级3眼,FDDT2级2眼）。结论先天性鼻泪管阻塞伴泪小管阻塞的患儿,只要存在一个正常泪小管,应用泪道探通术解除鼻泪管阻塞的前提下,患儿溢泪症状较术前均有明显改善,单纯鼻泪管阻塞患儿术后泪液引流作用要好于合并泪小管阻塞者,上或下泪小管均可能起到有效的引流泪液的功能。     

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.     

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.     

The management of nasolacrimal duct obstruction in children between 18 months and 4 years old.

PURPOSE: Success with nasolacrimal duct probing has been shown to be inversely correlated with age. Consequently, several authors have suggested that the older child with a previously untreated nasolacrimal duct obstruction should undergo silicone intubation or a balloon catheterization as the primary surgical procedure because older children are more likely to have complicated obstructions that will not respond to simple probing. The purpose of this study was to investigate the hypothesis that older children with uncomplicated nasolacrimal duct obstruction can be successfully managed with simple probing. METHODS: A 14-year prospective study was conducted of consecutive patients older than age 18 months with nasolacrimal duct obstruction. All were treated (subject to certain exclusion criteria) with a simple nasolacrimal duct probing. Careful attention was paid to the type of obstruction encountered at surgery. Outcome evaluation included a standard ophthalmologic examination plus a dye disappearance test at 6 weeks after surgery. A follow-up examination or telephone interview was conducted 1 year after surgery. RESULTS: Of 378 children undergoing nasolacrimal duct probing, 23 met the inclusion criteria of being older than age 18 months (18 to 48 months). Seventy percent of the 23 children had a good outcome from the probing procedure. When analyzed by the type of obstruction, 12 of the 12 children (100%) with a simple membrane at the valve of Hasner had a good outcome. This contrasted with a success rate of 4 of 11 children (36%) who had complicated obstructions (p < 0.01). Complicated nasolacrimal duct obstructions were more prevalent in older children. CONCLUSION: A simple probing of the nasolacrimal duct has an excellent success rate in children up to 4 years old if an uncomplicated obstruction is found at the valve of Hasner.     

Prevalence of amblyopia in children undergoing nasolacrimal duct irrigation and probing

Purpose:

To investigate ambylopia and amblyopia risk factors of children who underwent nasolacrimal duct (NLD) irrigation and probing for congenital nasolacrimal duct obstruction (CNLDO).

Materials and Methods:

The medical records of patients who had undergone NLD irrigation and probing for CNLDO at an age of 3 years or younger were reviewed, and 51 of the patients were recalled between October 1 and December 31, 2011 for a detailed ophthalmic examination to determinate amblyopia or amblyopia risk factors. Amblyopia was accepted as difference in visual acuity of two or more Snellen lines between the two eyes or visual acuity of 20/30 or worse in either eye.

Results:

The median age of the 51 patients to whom NLD irrigation and probing were attempted for CNLDO was 23 months. CNLDO affected a total of 70 eyes. All patients were reviewed for best-corrected visual acuity, refractive errors, and strabismus at a median age of 70.5 months (range 31-95 months). Amblyopia or amblyopia risk factors were identified in 14 patients (27.5%). One child (7.15%) had only strabismus, six children (42.8%) had only amblyogenic refractive errors, two (14.3%) had a combination of two, one child (7.15%) had a family history for amblyopia, but four children (28.6%) had no amblyopia risk factors but had amblyopia.

Conclusion:

Amblyogenic risk factors are found higher in patients with CNLDO and patients undergoing NLD irrigation and probing in comparison to normal population. Therefore, we recommend these children to routinely undergo cycloplegic refractions and full ophthalmic examinations.     

泪道探通联合硅胶支撑管环形置入的临床应用

目的观察泪道探通联合泪道内硅胶支撑管环形置入在鼻泪管阻塞及泪小管断裂中的临床效果。方法对鼻泪管阻塞48例（53眼）及泪小管断裂24例（24眼）,共72例（77眼）,施行泪道探通联合泪道内硅胶支撑管环形置管治疗。结果术后随访6月～1年,治愈58眼,好转15眼,无效4眼。结论泪道探通联合泪道内硅胶支撑管环形置入是治疗鼻泪管阻塞及泪小管断裂的有效方法。     

The prevalence of amblyogenic factors in children with persistent congenital nasolacrimal duct obstruction

Background

To evaluate the prevalence of amblyopia risk factors in children that underwent probing for persistent congenital nasolacrimal duct obstruction (CNLDO).

Methods

The medical records of children with CNLDO (after 1 year of age) that underwent probing were reviewed. Amblyopia risk factors, based on the American Association for Pediatric Ophthalmology and Strabismus referral criteria in 2013, were sought in the patients? records before probing. The proportion of the patients with anisometropia >1.5 diopters (D) was separately calculated. In unilateral cases of CNLDO, sphere, astigmatism, and spherical equivalent of the eyes with CNLDO were compared with contralateral eyes in order to assess the effect of CNLDO on refractive error. In the follow-up examinations, the success of the probing or the need for additional procedures (Crawford intubation, Monoka intubation, or dacryocystorhinostomy) was evaluated. The prevalence of anisometropia between ‘successful probing’ and ‘failed probing’ groups was compared.

Results

A total of 433 cases were included in the study. 41 cases (9.46 %) had amblyopia risk factors. Twenty-four cases (5.5 %) had anisometropia >1.5 D (spherical or cylindrical). In unilateral cases of CNLDO, the sphere and spherical equivalent of the eyes with CNLDO were significantly greater than those of the contralateral eyes (p?p?=?0.03).

Conclusions

The findings of greater prevalence of anisometropia >1.5 D (compared with the prevalence in the general population) and significantly greater sphere and spherical equivalents in the eye with CNLDO (compared with contralateral eye) in unilateral cases with CNLDO, suggested some relationships between anisometropia and long-term untreated CNLDO. The finding of more anisometropia in failed probing cases may support the theory of structural abnormality as an explanation for the possible relationship between congenital nasolacrimal duct obstruction and anisometropia.     

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.     

Factors affecting the success of nasolacrimal duct probing for congenital nasolacrimal duct obstruction.

PURPOSE: To ascertain the effect of certain parameters on nasolacrimal duct probing. METHODS: In a retrospective study of 142 infants and children who underwent nasolacrimal duct probing for congenital nasolacrimal duct obstruction, age at time of probing, gender, symptom severity, presence of mucous discharge, and history of probing were correlated with success of nasolacrimal probing. Success of probing was defined as complete resolution of signs and symptoms of nasolacrimal duct obstruction. Chi-square test was used to analyze covariance. RESULTS: Success of nasolacrimal duct probing was negatively correlated with increasing age: 92%, 89%, 80%, 71%, and 42% at age 12, 24, 36, 48, and 60 months, respectively (P = .001 at each interval). Increasing severity of epiphora was correlated with increased failure of nasolacrimal duct probing (P = .05). CONCLUSIONS: Although the success of nasolacrimal duct probing declines with age, probing in older children can remain the first line of treatment. Because increasing frequency of epiphora correlates with failure of nasolacrimal duct probing, children with daily epiphora should undergo early nasolacrimal duct probing.     

Long-term results of probing guided with soft cannula in children with congenital nasolacrimal duct obstruction

Purpose

To report the results of soft probing in children with congenital nasolacrimal duct obstruction (CNLDO).

Materials and Methods

A prospective, non-randomised interventional study included 158 eyes of 122 children aged 2 months–5 years, with CNLDO. A plastic intravenous catheter sheath supported intraluminally with a guiding metal probe was introduced through the superior canaliculus. During intubation, the plastic cannula was gently introduced through the nasolacrimal system, while the metal probe inside was withdrawn concurrently. After the complete withdrawal of the metal probe, the duct was irrigated with a high pressure saline solution through the plastic cannula. Once the obstruction was totally dissolved and a patent passage was observed, the plastic cannula was withdrawn and the procedure was completed with a nasolacrimal lavage with a gentamycin and dexamethasone combination.

Results

Clinically successful results were achieved in 142 eyes (89.8 %). No significant complications occured intraoperatively or postoperatively.

Conclusions

In children under age 5, our technique has a high success rate with no significant complications. This method allows probing in a more controlled way. This method may be particularly suitable for surgeons during training, when the most false lumen formation is observed.