Management of Epiphora in Children- Prospective Analysis

Abstract

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 ...