Initial nasolacrimal duct probing in children under age 5: Cure rate and factors affecting success

Kashkouli, Mohsen Bahmani; Kassaee, Abolfazl; Tabatabaee, Ziaeddin

doi:10.1067/mpa.2002.129041

Cited by 92 publications

(74 citation statements)

References 11 publications

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“…4,12,16,24 However, as the natural history of spontaneous resolution is well recognised, 3,[7][8][9][10]13 it has been suggested that the decreasing success rate with increasing age is actually due to the process of natural selection, with cases of simple membranous obstruction at the distal NLD resolving, while more complex obstructions persist and accumulate in number. 25 This argument has been supported by a controlled study of probing vs observation during the second year of life, which identified that both are equally effective during this time (probing and observation resulted in the same outcome in children with epiphora between 1 and 2 years of age), but that the rate of spontaneous resolution/ probing success was lower than during the first year of life.…”

Section: Discussionmentioning

confidence: 99%

“…Other reports have suggested that the success rate of probing is dictated not by the age at probing, but by the type of obstruction. [13][14][15][16][17] Simple obstructions at the valve of Hasner are the most common, but more complex anomalies do exist, which may be less amenable to disruption by simple probing alone. Endoscopic-assisted probing facilitates visualisation of the probe in the membranous nasolacrimal duct and in the inferior meatus of the nose.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic-assisted probing for congenital nasolacrimal duct obstruction

Wallace

Cox

White

et al. 2005

Eye

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic-assisted probing for congenital nasolacrimal duct obstruction

Wallace

Cox

White

et al. 2005

Eye

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“…17 Buna paralel olarak yaşın artmasıyla tedavi başarısının azaldığı dolayısıyla sondalamanın 3 yaş altındaki hastalara uygulanmasının uygun olacağı düşünülmüştür. 11,14,16,18 Bizim çalışmamızda da ilk sondalama başarısı 12-24 ay grubunda %80,95 iken 24 ay üzerindeki olgularda %44,44 olarak saptandı. Bu oranlar ülkemizden bildirilen çalışmalarla da benzerlik göstermektedir.…”

Section: Discussionunclassified

“…24 İleri yaş, ağır tıkanıklık bulgularının varlığı, bilateral tıkanıklık, kanaliküler darlık, atonik kese, anatomik varyasyonlar ve non-membranöz DNKT sondalamada başarısızlık için risk faktörleridir. 8,14,18 Klinik olgularımızdan sondalama tedavisine cevap vermeyen hastaların önemli kısmında işlem esnasında kanaliküler darlık tespit edilmiştir.…”

Section: Discussionunclassified

Doğumsal Nazolakrimal Kanal Tıkanıklığı Tedavisinde Sondalama Yönteminin Etkinliği

Esen¹,

Özcan²,

Erdem³

et al. 2012

tjo

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Sum maryPur po se: To investigate the outcome of probing in patients with congenital nasolacrimal duct obstruction and to evaluate the success rate among age groups. Ma te ri al and Met hod: The charts of patients who underwent probing for congenital nasolacrimal duct obstruction between 2008 and 2011 were reviewed. Patients' ages at the time of probing, the presence of watering complaints and epiphora, and fluorescein dye disappearance test results after the procedure were recorded. Findings were evaluated according to age groups. Re sults: Forty-six patients (24 girls (52.2%), 22 boys (47.8%)) diagnosed as congenital nasolacrimal duct obstruction were included in the study. Probing was performed to the right eye in 13 (28.3%), left eye in 13 (28.3%) and both eyes in 20 (43.4%) patients, i.e. to 66 eyes in total. Age at time of probing was between 18 days and 6 years (average: 23.5 months). Six patients were under 12 months, 26 patients were between 12 and 24 months, and 14 patients were over 24 months. Mean follow-up period was 4.32 (1-24) months. By probing, success was achieved in 48 of 66 eyes (72.72%). According to the age group, success rate of probing was 100% (6 of 6 eyes) in patients under 12 months, while it was 80.95% (34 of 42 eyes) in patients between 12-24 months and 44.44% (8 eyes of 18) in those over 24 months. Dis cus si on: In the first year of life, probing is an effective treatment for congenital nasolacrimal duct obstruction in cases not improving with conservative treatment. As the age increases, the chance of success decreases, thus the application should not be delayed. However, in selected cases with advanced age, it can be recommended prior to invasive treatments. (Turk J Ophthalmol 2012; 42: 342-5 GirişDoğumsal nazolakrimal kanal tıkanıklığı (DNKT) pediatrik hasta grubunda sıkça karşılaşılan, gözlerde sulanma, çapaklanma ve mükopürülan sekresyonla seyreden, çoğunlukla inflamasyon bulgusu olmasa da sekonder enfeksiyon gelişmesi durumunda konjonktivite, tedavi edilmediği taktirde dakriosistit, preseptal ve orbital sellülit gibi ciddi komplikasyonlara neden olabilecek önemli

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“…Several studies have found a significant increase in the failure rate in those patients undergoing probing after the age of 12 months. (27,20,23,29,30) Table 5 shows the success rate of probing reported in several studies. Resolution of symptoms can also be attributed to spontaneous resolution in children less than one year.…”

Section: Discussionmentioning

confidence: 99%

Management of Epiphora in Children- Prospective Analysis

Balakrishnan¹,

Mohanraj²,

Sowmiya³

et al. 2018

jemds

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BACKGROUND Lacrimation is caused by reflex over-production of tears from stimulation of the trigeminal nerve by irritation of the cornea or conjunctiva. In these cases, the excess watering is associated with symptoms of the underlying cause and treatment is usually medical. Obstructive epiphora is caused by mechanical obstruction of tear drainage. It is characterized by excessive watering which is exacerbated by a cold and windy atmosphere, and is least in a warm dry room. Most cases can be relieved by surgery. Lacrimal pump failure occurs secondary to lower lid laxity or weakness of the orbicularis muscle. Treatment is more difficult than that of obstructive epiphora. Purpose-To study success of various methods of treatment for epiphora in children below 11 years and to compare clinical profile between children below 2 years (early onset) and children above 2 years (late onset). Design-Prospective observational study. MATERIALS AND METHODSStudy was conducted in 209 eyes of 167 patients (42 bilateral cases) during five years period between Jan 2010 to Jan 2015. The success of treatment was defined as complete resolution of symptoms and negative regurgitation on pressure over lacrimal sac (ROPLAS) area; Patients were followed up for 8.4 ± 2.1 months. RESULTS87 percent (145 of 167) cases were below 2 years and 13 percent (22 of 167) were children above 2 years. The male: female ratio was 1.3:1. Seventy five percent cases were unilateral. Cause for 92% cases were congenital nasolacrimal duct obstruction (NLDO), 6% traumatic or surgical and 2% acquired NLDO. The success rate of total 209 cases were 98% (205 eyes), 89% for sac massage, 82% for probing, 64% for external dacryocystorhinostomy (DCR). Statistically significant relation was noted between the treatment result and laterality (P-0.04), symptom severity (P-0.027), previously treated cases (P-0.024) and age. All cases below 2 years with NLDO were completely cured by sac massage and few cases with probing. No significant association was found between treatment result and sex (P-0.73). CONCLUSIONProperly done sac massage alone for weeks to many months is best treatment for early onset NLDO in children less than 2 years. Probing was successful in 82% of children. Probing and DCR were required in older children. Mucoid discharge and recurrent ocular infection had decreased overall treatment success. There was significant correlation between laterality, symptom severity and previous treatment.] KEYWORDS Epiphora, Children, Observational Study, India. HOW TO CITE THIS ARTICLE: Balakrishnan M, Mohanraj K, Sowmiya KR, et al. Management of epiphora in children-prospective analysis. J. Evolution Med. Dent. Sci. 2018;7(09):1091-1095, DOI: 10.14260/jemds/2018/248 BACKGROUND Epiphora is excessive watering of eyes despite normal tear production due to any obstruction in lacrimal drainage pathway. Congenital nasolacrimal duct obstruction (CNLDO) is a common condition affecting 20% infants in their first year of life (1) and occurs due to the failure of canalization ...

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Initial nasolacrimal duct probing in children under age 5: Cure rate and factors affecting success

Cited by 92 publications

References 11 publications

Endoscopic-assisted probing for congenital nasolacrimal duct obstruction

Endoscopic-assisted probing for congenital nasolacrimal duct obstruction

Doğumsal Nazolakrimal Kanal Tıkanıklığı Tedavisinde Sondalama Yönteminin Etkinliği

Management of Epiphora in Children- Prospective Analysis

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