Probing for congenital nasolacrimal duct obstruction in older children

Abstract

Purpose:The purpose of this study was to evaluate the role of probing in congenital nasolacrimal duct obstruction in children age 2 years and older and to establish factors predictive of the outcome.Materials and Methods:A prospective study was conducted on consecutive patients older than 24 months with congenital nasolacrimal duct obstruction. All patients were treated with a simple nasolacrimal duct probing as primary treatment. Outcome measures included an ophthalmologic examination plus a parental history of residual symptoms at one and 6 months after surgery.Results:A total of 82 children with a mean age of 34.5 months (range, 24 months to 60 months) underwent nasolacrimal duct probing. The complete response rate was 54%. Partial response and failure were observed in 25% and 20.8% of the eyes, respectively. Bilateral obstruction was associated with failure of probing (P = 0.007, Odds Ratio: 5.76). However, age older than 36 months was not associated with the failure rate.Conclusion:Primary probing maintains a high success rate without any age related decline in congenital nasolacrimal duct obstruction.

Success rates of probing for congenital nasolacrimal duct obstruction at various ages

“…Some authors are in favor of performing the procedure later [ 20 , 28 , 33 , 34 , 36 ]. A prospective cohort study conducted by the Pediatric Eye Disease Investigator Group (PEDIG) did not show the relationship between the age at which the probing was performed and the success of this procedure up to 36 months of life [ 20 ].…”

“…A prospective cohort study conducted by the Pediatric Eye Disease Investigator Group (PEDIG) did not show the relationship between the age at which the probing was performed and the success of this procedure up to 36 months of life [ 20 ]. In turn, some ophthalmologist postulate that nasolacrimal duct probing in both younger and older children is equally effective, and that the failure of the surgery does not depend on the age, but on the cause of obstruction [ 32 , 34 , 38 , 39 ]. According to some retrospective studies, the percentage of unsuccessful procedures is greater in older age group due to a self-selection process.…”

“…Bilateral obstruction, occurring in 9–47.5% [ 3 , 4 , 9 , 11 , 18 – 20 , 23 , 26 – 29 , 31 , 33 , 34 , 36 , 38 – 40 ] may indicate a more complicated cause of the condition, create greater technical difficulties during procedures performed under local anesthesia, and thus affect the obtainment of less-satisfactory results, which is also confirmed by our study and reports by other researchers [ 20 , 36 ]. Dietze et al [ 43 ] suggest that patients with trisomy 21, allergic rhinitis/seasonal allergies, history of an upper respiratory tract infection within 1 month and obstructive sleep apnea may be correlated with a higher risk of failure with a probing.…”