A randomized trial comparing cost-effectiveness of immediate office probing versus observation with deferred facility probing for unilateral congenital nasolacrimal duct obstruction

Lee, Katherine A.; Chandler, Danielle L.; Repka, Michael X.; Beck, Roy W.; Foster, Nicole C.; Frick, Kevin D.; Golden, Richard P.; Lambert, Scott R.; Melia, Michele; Tien, David Robbins; Weakley, David R.

doi:10.1016/j.jaapos.2011.12.023

Cited by 2 publications

(32 citation statements)

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“…Of these 13 references, we deemed 7 (comprised of 6 publications plus 1 trial registry entry) to be eligible for the review. Five of the publications and the trial registry entry all referred to the same trial (PEDIG 2012). The other publication was a single report of another trial (Young 1996).…”

Section: Resultsmentioning

confidence: 99%

“…Participants in the PEDIG 2012 trial were 6 to 10 months old at the time of enrollment and had not had previous surgery for NLDO; a history of NLDO treatment with lacrimal massage, topical antibiotics or steroids, or systemic antibiotics was permitted. Young 1996 described participants’ age as “approaching or just after their first birthday,” and did not have a history of previous lacrimal procedures.…”

Section: Resultsmentioning

confidence: 99%

“…It is unclear whether conservative treatment such as massage and antibiotics were allowed, though it was reported that babies who had persistent conjunctival hyperemia and discharge “except while on antibiotics” were excluded from randomization and probing was advised. PEDIG 2012 reported that symptoms of NLDO should have started before the age of six months. For both studies participants with bilateral NLDO had both eyes assigned to the same treatment; however, eyes were analyzed as independent units of analysis.…”

Section: Resultsmentioning

confidence: 99%

“…In PEDIG 2012, participants were randomized to immediate office probing using topical anesthesia and a gentle restraint or to six months of observation and when necessary, deferred facility probing for unresolved cases. During the six-month observation period, participants’ parents received instructions to provide lacrimal massage whenever discharge was present and to use antibiotic eyedrops when discharge was purulent.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, controversy exists regarding the timing of probing (PEDIG 2012; Tan 2001). The decision to probe early (< 12 months) versus late (> 12 months) is usually based on the surgeons’ clinical judgement and experience.…”

Section: Introductionmentioning

confidence: 99%

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Probing for congenital nasolacrimal duct obstruction

Petris

Liu

2017

Cochrane Database of Systematic Reviews

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Background Congenital nasolacrimal duct obstruction (NLDO) is a common condition causing excessive tearing in the first year of life. Infants present with excessive tearing or mucoid discharge from the eyes due to blockage of the nasolacrimal duct system, which can result in maceration of the skin of the eyelids and local infections, such as conjunctivitis, that may require antibiotics. The incidence of nasolacrimal duct obstruction in early childhood ranges from 5% to 20% and often resolves without surgery. Treatment options for this condition are either conservative therapy, including observation (or deferred probing), massage of the lacrimal sac and antibiotics, or probing the nasolacrimal duct to open the membranous obstruction at the distal nasolacrimal duct. Probing may be performed without anesthesia in the office setting or under general anesthesia in the operating room. Probing may serve to resolve the symptoms by opening the membranous obstruction; however, it may not be successful if the obstruction is due to a bony protrusion of the inferior turbinate into the nasolacrimal duct or when the duct is edematous (swollen) due to infection such as dacryocystitis. Additionally, potential complications with probing include creation of a false passage and injury to the nasolacrimal duct, canaliculi and puncta, bleeding, laryngospasm, or aspiration. Objectives To assess the effects of probing for congenital nasolacrimal duct obstruction. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Trials Register (2016, Issue 8); MEDLINE Ovid (1946 to 30 August 2016); Embase.com (1947 to 30 August 2016); PubMed (1948 to 30 August 2016); LILACS (Latin American and Caribbean Health Sciences Literature Database; 1982 to 30 August 2016), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), last searched 14 August 2014; ClinicalTrials.gov (www.clinicaltrials.gov), searched 30 August 2016; and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en), searched 30 August 2016. We did not use any date or language restrictions in the electronic searches for trials. Selection criteria We included randomized controlled trials (RCTs) that compared probing (office-based or hospital-based under general anesthesia) versus no (or deferred) probing or other interventions (observation alone, antibiotic drops only, or antibiotic drops plus massage of the nasolacrimal duct). We did not include studies that compared different probing techniques or probing compared with other surgical procedures. We included studies in children aged three weeks to four years who may have presented with tearing and conjunctivitis. Data collection and analysis Two review authors independently screened studies for inclusion and independently extracted data and assessed risk of bias for the included studies. We analyzed data using Review Manager software and evaluated the certainty of the evidence using GRADE. Main...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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