Infantile Endoscopic Dacryocystorhinostomy: Indications, Anatomical Considerations, and Outcomes

Abstract

The purpose of this case series is to report the demographic profile, indications, anatomical considerations, and outcomes of Endonasal endoscopic DCR in the infants. Five eyes of 3 infants underwent IEnDCR with a mean age of 4.26 months (range: 23 days–8 months). There were 2 males and 1 female. Two of the infants underwent bilateral surgery. The indication for surgery in the infant undergoing unilateral surgery was recurrent acute dacryocystitis and lacrimal abscess formation secondary to refractory and complex congenital nasolacrimal duct obstruction. Infants undergoing bilateral lacrimal surgery had refractory complex congenital nasolacrimal duct obstruction and were in need for an early intraocular surgery for associated ocular morbidities. Mitomycin-C (0.02% for 3 minutes) and silicone intubation was used in all cases. At follow up of 9 months, all the 3 infants demonstrated anatomical and functional success. The surgical technique requires certain modifications in order to cater to the unique challenges. It is safe and effective in experienced hands and can be considered as an alternative to an external DCR in infants.

Multidisciplinary approach to lacrimal system diseases

“…All these different approaches, commonly performed by an ophthalmic plastic surgeon, provide a success rate of up to 90%. In the event of challenging cases, endoscopic endonasal dacryocystorhinostomy (END-DCR) is an established procedure to address unmanageable congenital obstructions, making a multidisciplinary approach with an ENT a possibility in case of this refractive form 26 . Considering the adult form of distal lacrimal obstruction (DALO), the most common pathologies can be distinguished as oncologic and non-oncologic (primary and secondary) forms.…”

Congenital Nasolacrimal Duct Obstruction Update Study (CUP Study): Paper 4—Infantile Acute Dacryocystitis (InAD)—Presentation, Management, and Outcomes

“…The need for general anesthesia may influence the cognitive development of these infants. 30 An interesting aspect of this series was the mean duration (4.66 weeks) of the lacrimal symptoms before presentation. This clearly reflects neglected care or delay in seeking or getting medical care.…”

Kelainan Sistem Lakrimal Pada Anak

“…Etiologi yang paling umum adalah kegagalan katup Hasner untuk membuka. [2,19] Bayi prematur memiliki tingkat obstruksi saluran nasolakrimal yang jauh lebih tinggi. Namun, karena produksi air mata tidak terjadi dalam waktu dekat, bayi ini tidak menunjukkan gejala epifora.…”

“…Penyebab lain dari epifora infantil termasuk keratitis, benda asing, atau agenesis pungtum lakrimal. [19] Tatalaksana obstruksi saluran nasolakrimal, pada awalnya, konservatif dan akan terjadi perbaikan spontan. Intervensi bedah terdiri dari penggunaan probe logam fleksibel ke saluran nasolakrimal untuk membukanya.…”