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

https://doi.org/10.1067/mpa.2002.129041Get rights and content

Abstract

Aims: To evaluate the success rate of initial probing and the factors affecting the success rate for congenital nasolacrimal duct obstruction (CNLDO)in children under the age of 5 years. Methods: In a prospective uncontrolled interventional case series, 207 eyes from 161 consecutive patients with CNLDO underwent nasolacrimal duct probing under brief general anesthesia. Based on exclusion criteria, 180 eyes from 139 patients were included in the study. Diagnoses were made according to the patients' histories, clinical examinations, and modified dye disappearance tests. The state of the punctum, the canaliculus, the sac, and the nasolacrimal duct were recorded. The main outcome measure was the complete disappearance of tearing and discharge in the affected eye. The patients were followed at 1 week, 1 month, and 3 months postoperatively. Results: The age range was 5 to 60 months (mean, 19.1 ± 11.2 months). The cure rates were 92% in the first year, 84.5% in the second year, 65% in the third year, and 63.5 in the fourth and fifth years of age. The patient's age, nonmemberanous CNLDO, and canalicular stenosis were correlated with the success of initial nasolacrimal duct probing (P <.05). Conclusions: Based on the results, simplicity of probing, and absence of significant complications, initial nasolacrimal duct probing is advised up to the age of 5 years. Increasing age, nonmembranous CNLDO, and canalicular stenosis increase the failure rate (P <.05). (J AAPOS 2002;6:360-3)

Section snippets

Subjects and methods

A survey of patients below the age of 5 years with CNLDO was conducted. A questionnaire was prepared to obtain the following data: age, sex, eye complaints (tearing, mucopurulent discharge, swelling or infection of the sac, aberrant opening of the lacrimal draining system onto the skin), mother's age at pregnancy, type of delivery (natural, cesarean), history of prior conservative treatment (massage and topical antibiotics), history of repeated conjunctivitis, and lid malposition. The exclusion

Results

In a prospective uncontrolled interventional case series, 207 eyes of 161 patients were evaluated. Twenty-seven eyes were excluded based on the exclusion criteria; 180 eyes from 139 patients were studied. Sixty-nine patients (49.6%) were boys. The ages of the patients at the probing were 5 to 60 months (mean ± SD, 19.18 ± 11.28) (Table 1).The mothers' ages at pregnancy varied between 16 and 38 years (mean, 24 ± 5.06 years). The type of delivery in 57 (41%) patients was cesarean section. The

Discussion

The incidence of symptomatic CNLDO is 3% to 6%.1 However, postmortem examinations of term and premature infants within the first month of birth suggested that the incidence of obstruction is 52% (unilateral or bilateral).3 There are 8 different types of CNLDO.3, 4 The most common, membranous obstruction, has the best response to treatment.4 The treatment of CNLDO can be either conservative or surgical.5 More than 90% of the eyes of patients with CNLDO resolve within the first 12 months of life.6

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Reprint requests: Mohsen Bahmani Kashkouli, MD, Eye Department, Norfolk and Norwich University Hospital, Norwich NR4 7UZ, United Kingdom; e-mail, [email protected].

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