Tomomichi Nakayama, Akihide Watanabe, Saul Rajak, Yukito Yamanaka, Chie Sotozono
Purpose To investigate spontaneous resolution of congenital nasolacrimal duct obstruction (CNLDO) beyond 12 months of age in Japanese infants.
Methods Retrospective, observational case series. We retrospectively reviewed the clinical records of patients diagnosed with CNLDO beyond 12 months of age at Kyoto Prefectural University Hospital, Kyoto, Japan. This study involved 155 cases of CNLDO in 133 Japanese infants diagnosed with CNLDO. All patients chose intervention with either dacryoendoscopic guided probing and stenting or conservative management. The proportion and age of patients who had spontaneous CLNDO resolution were analysed.
Results The patients were divided into two groups: (1) 62 patients with 70 obstructed nasolacrimal ducts (45%) in whom spontaneous resolution occurred and (2) 71 patients with 85 obstructed nasolacrimal ducts (55%) who underwent dacryoendoscopic guided probing and stenting. The mean age of spontaneous resolution was 17.8±5.3 months (range: 12.0–35.4 months). Dacryoendoscopic guided probing and stenting were successful in 83/85 (97.6%) of cases.
Conclusions Spontaneous resolution of CNLDO can occur in 45% of infants over the age of 12 months. Dacryoendoscopic guided stenting also has high success rates in this patient group, and both treatment options can be proposed to caregivers.
Qin Xiang, MM; Xu Gao, MD; Xinke Chen, MM; Jian Qi, MD; Jing Fang, MD
To investigate the success rate of probing for young children with nasolacrimal duct obstructions and the risk factors involved.
The medical records of 3,143 patients (3,928 eyes) who received nasolacrimal duct probing in southwest China were collected. These included delivery method, age and gender, preoperative treatments, anesthesia methods, probing procedure, and follow-up clinical records. Then the relationship between the success rates of the probing and a few probable risk factors were analyzed.
Children delivered by eutocia were more likely than those delivered by cesarean section to have nasolacrimal duct obstruction. The total success rate of the probing was 85.2%. Patients older than 19 months had a lower completion rate compared with those younger than 1 year (P < .01). In the follow-up observations, the younger age groups were more likely to have higher success rates than the older ones (P < .05) using pairwise comparison. The success rates also had a significant relationship with the type of obstruction and older patients were more likely to have complex obstruction (odds ratio: 1.13, 95% confidence interval: 1.08 to 1.19, P < .001).
This large-scale study proved several factors affect the success rate of nasolacrimal duct probing, and confirmed children delivered by eutocia were more likely to have nasolacrimal duct obstruction.
Austin Bach, DO, MPH; Elizabeth Ann Vanner, PhD, MS; Roberto Warman, MD
To analyze the efficacy of nasolacrimal duct probing conducted in the office for nasolacrimal duct obstruction.
A retrospective chart review was conducted of 1,294 patients. Of those, 1,227 patients who underwent office-based nasolacrimal probings of the nasolacrimal duct at a single tertiary care center were included.
A total of 82 (6.7%) patients needed reprobing. Of the 82 patients who underwent a second procedure, 35 (43%) underwent a second in-office probing with a success rate of 77%. The 8 (22%) patients who failed the second in-office probing underwent probing and Crawford stent placement in the operating room and their symptoms resolved. For the 47 (57%) patients who failed the primary in-office probing and underwent operating room probing and stent placement, only 1 (2%) needed a second operating room probing and stent placement. Logistic regression analyses indicated an increased likelihood of needing a secondary procedure with increased age at the time of the first probing.
This large, retrospective analysis of office-based probings demonstrated a success rate of 93.3% with increased likelihood of not needing a second procedure with probing at a younger age. This study demonstrates an excellent success rate for in-office probings for patients both younger and older than 12 months. This not only shows a high rate of efficacy, but is also highly cost efficient when compared to primary probing in the operating room.
Alaa S. Bou Ghannam, MD; Carl-Joe Mhanna, MD; Marwan Atallah, MD; Ramzi M. Alameddine, MD
An 18-day-old female neonate presented to clinic with bilateral enlarging infraorbital bluish masses and mucopurulent discharge from both eyes. She was born full term with no complications during pregnancy and delivery. The parents noticed the swelling shortly after birth, with progressive enlargement mostly on the left side associated with labored breathing. Clinical examination revealed bilateral indurated cystic lesions with a bluish hue below the medial canthi, more prominent on the left side (Figure 1). There was overlying skin, soft tissue swelling, and redness. On digital pressure, copious mucopurulent material was expressed onto the ocular surface. The ophthalmologic examination was otherwise unremarkable. The neonate was noted to have audible grunting and respiratory distress. Computed tomography scan showed bilateral large cystic lesions in the lacrimal fossa area associated with intranasal cysts. At 2 months of age, she underwent bilateral probing and irrigations and has since done well.
Nishi Gupta, Chawla Neeraj, Bansal Smriti & Das Sima
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.
Ashok Kumar Grover
Nasolacrimal duct obstruction (NLDO) in children is congenital in most cases. Noncanalization of the inferior caudal end of the duct is the most common cause. Spontaneous resolution of the obstruction occurs in 96% of affected children in the first year in the natural course and conservative management is the mainstay. Traditional treatment is a hydrostatic massage of the sac. Although there are proponents of early probing, most surgeons prefer to delay their intervention to the age of about one year. Success rates for primary probing are up to 97% during the first year. Good success rates have been reported in older children as well (88% at age 12–101 months, mean 33 months). Factors implicated in failure of probing include improper technique, late age of probing, anatomical variations (complex NLDO), inferior turbinate hypertrophy/impaction, or associated nasal pathology……
Bahram Eshraghi, Mansooreh Jamshidian-Tehrani & Arash Mirmohammadsadeghi
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.