Endoscopic-assisted probing for congenital nasolacrimal duct obstruction

Abstract

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.

Efficacy of probing for children with congenital nasolacrimal duct obstruction: a retrospective study using fluorescein dye disappearance test and lacrimal sac echography

“…Although probing is characterized by a high cure rate [10], its effectiveness seems to be reduced with increasing age and, thus, surgery timing is still controversial [8,[11][12][13][14][15][16][17][18][19][20][21][22]. Several trials have pointed out that the increasing prevalence of more complex CNLDO cases is the main risk factor for probing failure in older children, and that characteristics and/or site of obstruction have a greater prognostic influence than patient age [10,[23][24][25]. In CNLDO patients, nasolacrimal duct probing can result in intra-or post-operative problems: (1) peculiar anatomo-pathologic conditions, such as non-membranous CNLDO [23,24,26], (2) surgical complications, i.e., false passage formation, prolonged nasal bleeding, traumatic stenosis, lacrimal punctum damage, inflammatory and fibrous phenomena [12,18,19,23,[26][27][28], (3) functional block with patent lacrimal outflow pathways [13,29], and/ or (4) non-inflammatory swelling of the lacrimal sac (LS) [19,30].…”

“…Several trials have pointed out that the increasing prevalence of more complex CNLDO cases is the main risk factor for probing failure in older children, and that characteristics and/or site of obstruction have a greater prognostic influence than patient age [10,[23][24][25]. In CNLDO patients, nasolacrimal duct probing can result in intra-or post-operative problems: (1) peculiar anatomo-pathologic conditions, such as non-membranous CNLDO [23,24,26], (2) surgical complications, i.e., false passage formation, prolonged nasal bleeding, traumatic stenosis, lacrimal punctum damage, inflammatory and fibrous phenomena [12,18,19,23,[26][27][28], (3) functional block with patent lacrimal outflow pathways [13,29], and/ or (4) non-inflammatory swelling of the lacrimal sac (LS) [19,30]. Endoscopic-assisted probing may represent a useful procedure to minimize some of these inconveniences [23,29]; however, its routine employment is often hardly applicable during clinical practice.…”

Pediatric endonasal endoscopic dacryocystorhinostomy

“…In case of inferior canalicular stenosis, tearing disappeared after the retrieve of the stent but reappeared only temporarily during a viral rhinitis. The duration of the follow-up for the primary DCRs was 10.5 months (range: [6][7][8][9][10][11][12][13][14][15].…”

“…This is usually done by the ophthalmologists without concomitant nasal endoscopy [7]. An endoscopically assisted probing performed by a team comprising an ophthalmologist and an ENT surgeon is more effective [7][8][9][10]. The success rate is about 90%.…”

Congenital Nasolacrimal Duct Obstruction

“…Other causes of persistent symptoms include punctal stenosis, canalicular obstruction, upper nasolacrimal duct obstruction, and physiological obstruction [ 4 ]. Their recognition is important during repeat procedure and should be appropriately addressed.…”