Primary treatment of nasolacrimal duct obstruction with balloon catheter dilation in children younger than 4 years of age

Abstract

Purpose-To report the outcome of nasolacrimal duct balloon catheter dilation as the primary treatment of congenital nasolacrimal duct obstruction (NLDO) in children less than 4 years of age.Methods-102 children (151 eyes) aged 12 to <48 months (mean 23 months) at the time of surgery, with no prior nasolacrimal surgical procedure, and with at least one of the following clinical signs of NLDO present, epiphora, mucous discharge and/or increased tear lake, were enrolled in a prospective, non-randomized observational multicenter study (20 sites). All children received balloon catheter dilation of the nasolacrimal system of the affected eye(s).Results-Treatment success was defined as no epiphora, mucous discharge, or increased tear lake present at the outcome visit one month after surgery. The proportion of eyes treated successfully was 82% (95% confidence interval = 74% to 88%). The dye disappearance test at outcome was normal in 105 (73%), indeterminate in 15 (10%), and abnormal in 23 (16%) of the 143 eyes tested. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-In children 12 to <48 months of age, balloon catheter dilation as a primary treatment of NLDO was successful in about 80% of cases. Because we did not perform a randomized trial with a comparison group, we are unable to determine how this procedure's success rate compares with that of simple probing or nasolacrimal intubation in this age group.

Effect of age on primary balloon dacryocystoplasty and probing success in congenital nasolacrimal duct obstruction

“…Still, this result was not statistically signi cant (p=0.526) [12]. Another study, conducted by the Pediatric Eye Disease Investigator Group, showed that primary BDP's failure rate was 14% for patients between 12 and 24 months old, and this rate increased to 25% for patients between 24 and 48 months old (mean age: 23 months) [15]. Although the failure rate was reported to increase with patients' age, no statistical evaluation was reported between these two groups [15].…”

“…Another study, conducted by the Pediatric Eye Disease Investigator Group, showed that primary BDP's failure rate was 14% for patients between 12 and 24 months old, and this rate increased to 25% for patients between 24 and 48 months old (mean age: 23 months) [15]. Although the failure rate was reported to increase with patients' age, no statistical evaluation was reported between these two groups [15]. Interestingly, in the recent research by Gazit I. et al, it was found that the primary BDP success rate was signi cantly decreased after 36 months of age, quite similar to our study [16].…”

“…In general, BDP is used as a second-line treatment in primary probing failure cases, with a reported success rate of 74-94% [10]. In addition, some authors have reported that BDP offers a good outcome when used as a primary treatment for CNLDO, especially among older children and different obstruction types [11][12][13][14][15][16]. On the other hand, to our best knowledge, there are only two studies in the literature that compared probing versus BDP as primary treatment [17,18].…”

Comparison of Hasner valvulotomy outcomes in pediatric and adult patients: does age matter?

“…[ 6 ] The success rates of these treatments vary greatly. In particular, success rate of probing and SI are 33.3% to 97.0% [ 6 – 9 ] and 50.7% to 53.8%, [ 10 , 11 ] respectively. For ANDLO patients, success rate of endonasal endoscopic dacryocystorhinostomy (En-DCR) is 93.4% with silicone tubing and 92.2% without silicone tubing.…”

The study of risk factor for congenital dacryocystitis

“…Etiology of CNLDO is most commonly a membranous obstruction at level of valve of Hasner or stenosis of the duct or non-canalization. Incomplete canalization is the most common cause of CNLDO and occurs at the distal end resulting in an imperforate membrane at the valve of Hasner [6]. Other cause is proximal lacrimal outflow dysgenesis which occurs due to maldevelopment of punctum and canaliculus.…”