The management of nasolacrimal duct obstruction in children between 18 months and 4 years old

Efficacy of probing for children with congenital nasolacrimal duct obstruction: a retrospective study using fluorescein dye disappearance test and lacrimal sac echography

PURPOSE

To evaluate B-scan echography for the assessment of lacrimal sac (LS) in pediatric epiphora secondary to congenital nasolacrimal duct obstruction (CNLDO), and to verify its predictive role in functional efficacy of nasolacrimal duct probing.

PATIENTS AND METHODS

Thirty-nine eyes of 23 consecutive children, treated with a single probing for persistent CNLDO-related epiphora, were retrospectively studied. These cases were investigated both collectively and considering two sub-groups: group A (ten patients [20 eyes] <or=13 months) and group B (13 patients [19 eyes] >13 months. Fluorescein dye disappearance test at 10 minutes (FDDT-10) and ultrasound examination of LS were performed before and after probing. An echographic LS scoring system (grade 0 = no LS enlargement; grade 1 = slight longitudinal LS enlargement; grade 2 = longitudinal and slight transverse LS enlargement; grade 3 = marked longitudinal and transverse LS enlargement) was introduced as a predictor of probing efficacy, estimating FDDT-10 modification between pre- and post-operative checks.

RESULTS

Echographic LS evaluation was easily practicable without sedation. In the total cluster and in both age sub-groups, post-probing FDDT-10 decreased with respect to pre-probing value (p < 0.001). Post-probing LS score improved with respect to pre-probing check within the total cluster and group A (p < 0.05). Strong correlation between pre-probing LS alteration and functional probing failure was present in each studied cluster (all p values <0.0001). Within group B, a greater gain of post-probing FDDT-10 was more frequent in patients with a better pre-probing LS score, as well as in younger children (both p values <0.0001).

CONCLUSIONS

In children with CNLDO-related epiphora, B-scan echography of the LS can represent a reliable and useful examination for a better understanding of the functional prognosis after probing treatment.

Success rate and cause of failure for late probing for congenital nasolacrimal duct obstruction

PURPOSE

To evaluate the outcome of late probing for congenital nasolacrimal duct obstruction in children 2 to 6 years old and to identify the cause of failure in these children.

METHODS

Records of 65 nasolacrimal duct obstructions in 62 children (39 boys and 23 girls) aged 2 to 6 years who underwent primary probing for congenital nasolacrimal duct obstructions were evaluated. The main observations were the type of obstruction encountered during probing (complex/simple), age at the time of probing, and success rate depending on the type of obstruction. Success was the main outcome measure and was defined as complete resolution of all signs and symptoms at 1 week of follow-up. The Mann-Whitney test for statistical significance was used to compare the results between simple and complex nasolacrimal duct obstructions.

RESULTS

Six children had bilateral obstruction. The average age at the time of probing was 37.71 months in children with complex obstruction and 37.27 months in children with simple obstruction. Twenty-one eyes (32.20%) had complex obstruction and 44 eyes (67.69%) had simple obstruction. The success rate was 33% in children with complex obstruction and 97.72% in children with simple obstruction, which was statically significant. The overall success rate of the whole cohort was 76.92%.

CONCLUSION

Older children with simple obstruction undergoing late probing had an excellent success rate in this study (97.72%). Complex obstruction is the main risk factor for failure of probing in older children. Probing is a successful and viable option in older children.

Primary treatment of nasolacrimal duct obstruction with probing in children younger than 4 years

OBJECTIVE

To report the outcome of nasolacrimal duct probing as the primary treatment of congenital nasolacrimal duct obstruction (NLDO) in children younger than 4 years.

DESIGN

Prospective nonrandomized observational multicenter study (44 sites).

PARTICIPANTS

Nine hundred fifty-five eyes of 718 children 6 to <48 months old 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 increased tear lake.

INTERVENTION

Probing of the nasolacrimal system of the affected eye.

MAIN OUTCOME MEASURE

Treatment success was defined as no epiphora, mucous discharge, or increased tear lake present at the outcome visit 1 month after surgery.

RESULTS

Proportions of eyes treated successfully were 78% (95% confidence interval [CI], 75%-81%) overall, 78% for the 421 eyes in children 6 to <12 months old, 79% for the 421 eyes in children 12 to <24 months, 79% for the 37 eyes in children 24 to <36 months, and 56% for the 11 eyes in children 36 to <48 months. The probability of treatment success was lower in eyes operated in an office setting than in eyes operated in a surgical facility (adjusted relative risk, 0.88 [95% CI, 0.80-0.96]), with success reported in 72% (95% CI, 66%-78%) of probings performed in an office and 80% (95% CI, 77%-84%) of probings performed in a facility. The probability of treatment success was also lower in eyes of patients with bilateral disease (adjusted relative risk, 0.88 [95% CI, 0.81-0.95]).

CONCLUSIONS

In children 6 to <36 months old, probing is a successful primary treatment of NLDO in about three fourths of cases, with no decline in treatment success with increasing age. The study enrolled too few children ages 36 to <48 months to allow a conclusion regarding the probability of treatment success in this age group.

Monocanalicular silastic intubation for the initial correction of congenital nasolacrimal duct obstruction

BACKGROUND

Treatment of persistent nasolacrimal duct (nasolacrimal duct obstruction) obstruction traditionally has consisted of simple probing. The most common complication with this approach has been recurrent obstruction, requiring another probing, often with the use of bicanalicular silastic intubation. Monocanalicular silastic tubing offers the possibility of increased success rates over simple probing while theoretically minimizing the insertion and removal difficulaties posed by bicanalicular techniques. We report, to our knowledge, the largest series to date of patients undergoing monocanalicular silastic intubation, as well as the first report evaluating this technique as the primary treatment for congenital nasolacrimal duct obstruction obstruction.

METHODS

This was a retrospective chart review of 635 children treated by 3 pediatric ophthalmologists via probing with monocanalicular silastic intubation as the initial procedure for congenital nasolacrimal duct obstruction obstruction. Success was defined as good clearance of fluorescein dye and/or the absence of symptomatic tearing. Failure was defined as recurrent symptomatic tearing or inadequate clearance of fluorescein dye, leading to the performance of a second tear duct operation.

RESULTS

We identified 635 children who underwent probing with monocanalicular intubation as the primary treatment for congenital nasolacrimal duct obstruction obstruction (mean age at time of probing 18 months). The overall success rate for the 803 eyes undergoing surgery was 96%. The success rate for treatment performed in infants younger than 24 months of age (684 eyes) was 97%, declining to 90% when surgery was performed in infants older than 24 months of age (119 eyes; p < 0.001). These success rates compare favorably to previous reports of primary probing without silastic intubation, especially in children older than 12 months at the time of the probing. The only complication in the current study was conjunctival-corneal abrasion, occurring in 2% of cases.

CONCLUSIONS

Probing with monocanalicular silastic intubation as the initial surgical procedure for patients with congenital nasolacrimal duct obstruction obstruction is associated with a very high success rate and low complication rate, especially when performed by the age of 24 months.

Outcomes in children with nasolacrimal duct obstruction: Significance of persistent symptoms while stents are in place

To evaluate the correlation between persistent symptoms while stents are in place and final outcome in children with nasolacrimal duct obstruction (NLDO). A retrospective observational case series, with medical record review that included indications for surgery, surgical procedure, presence of symptoms while stents were in place, and final outcome after stent removal. Twenty-eight children with NLDO had nasolacrimal duct stents placed in 42 eyes. Twenty-one of the 42 eyes (50%) had minimal or no signs or symptoms of NLDO while stents were in place, and 18 of 21 (86%) were symptom-free after stent removal. Twenty-one of the 42 eyes (50%) remained symptomatic while stents were in place. Eleven of these 21 eyes (52%) had good outcomes after stent removal. Ten (48%) of these patients had persistent symptoms after stent removal requiring further treatment. The prognosis for a good outcome is excellent if symptoms of NLDO resolve while stents are in place. The prognosis is poorer if symptoms of NLDO persist, but more than half of such patients still have good outcomes. Careful counseling of parents regarding these outcomes should be performed before considering additional interventions.

Inferior turbinate fracture and congenital nasolacrimal duct obstruction

PURPOSE

To evaluate the success rate of probing combined with inferior turbinate fracture in comparison with simple probing as a first attempt in the treatment of congenital nasolacrimal duct obstruction in children.

METHODS

In a prospective interventional case-control study, 86 eyes from 61 children older than 6 months with congenital nasolacrimal duct obstruction underwent surgical intervention. Forty-two eyes of 33 patients underwent probing combined with infracturing of the inferior turbinate and 44 eyes of 28 patients underwent simple probing. The outcome evaluation included a standard ophthalmologic examination plus a dye disappearance test 2 months after the surgical intervention.

RESULTS

In the case group (probing + infracture of the inferior turbinate), the results were good in 22 (66.7%) patients, fair in 8 (24.2%), and poor in 3 (9.1%). In the control group (simple probing), the results were good in 20 (71.4%) patients, fair in 3 (10.7%), and poor in 5 (17.9%) (p=0.9). Success rates were 91% and 82% in the case and control groups, respectively (p=0.4).

CONCLUSIONS

Based on the results of this study, infracturing of the inferior turbinate does not increase the success rate of simple probing as a first attempt.

Stepwise treatment paradigm for congenital nasolacrimal duct obstruction

PURPOSE

To compare the outcomes achieved by a series of patients treated in a stepwise fashion who presented with congenital nasolacrimal duct obstruction.

METHODS

In this retrospective interventional case series, 127 patients, ranging in age from 1 month to 81 months, with 173 lacrimal systems diagnosed with congenital nasolacrimal duct obstruction, were treated in a stepwise fashion. A treatment paradigm was evaluated that prescribed probing as an initial procedure regardless of age. Those who failed probing received balloon catheter dilation. Those who failed probing and balloon catheterization received silicone intubation. Dacryocystorhinostomy was reserved for patients failing the above treatments. Clinical success was defined as complete resolution of symptoms. Success rates at each step were evaluated, and a cost analysis was performed.

RESULTS

Lacrimal probing was successful in 134 of 173 (76.9%) cases. Of the 39 probing failures, 32 (82.1%) were cured with balloon catheterization. All 7 cases (100%) that failed probing and balloon catheterization were cured with silicone intubation. No patient in this series required dacryocystorhinostomy.

CONCLUSIONS

A stepwise approach to the treatment of congenital nasolacrimal duct obstruction is a clinically and financially effective model for treatment.

Balloon dacryocystoplasty as the primary treatment in older children with congenital nasolacrimal duct obstruction

PURPOSE

To report the outcomes of balloon dacryocystoplasty of the lacrimal duct with inferior turbinate infracture as a primary treatment of congenital nasolacrimal duct obstruction in children 18 months of age or older.

MATERIALS AND METHODS

This study was a 3-year, prospective, interventional case series, consisting of 83 consecutive patients with congenital nasolacrimal duct obstruction who underwent balloon dacryocystoplasty as their primary treatment modality. Outcome evaluations included an ophthalmologic examination and a dye disappearance test at 3 weeks and 6 months postoperatively. We analyzed the different age groups and the types of obstruction noted at surgery to determine their respective influences on patient outcomes. We used the chi-square test for statistical analysis.

RESULTS

Seventy-two patients aged 18 to 112 months (mean 30 months) were included. Overall, 57 patients (79%) had good outcomes from balloon dacryocystoplasty. When analyzed by type of obstruction, 34/42 patients (81%) with simple membranous obstruction at the valve of Hasner had good outcomes and 23/30 patients (77%) with stenosis that extended along the length of the distal NLD had good outcomes (P = 0.60, power 0.62). Age did not significantly affect outcomes (P = 0.66, power 0.72).

CONCLUSIONS

Balloon dacryocystoplasty is probably more effective than simple probing in older children with stenosis extending along the distal nasolacrimal duct obstruction.

Endonasal dacryocystorhinostomy in children

AIM

To verify whether our results with endonasal endoscopic dacryocystorhinostomy in children with nasolacrimal duct obstruction allow us to consider this technique a valid treatment alternative for children.

STUDY DESIGN

clinical with transversal cohort.

MATERIAL AND METHOD

Twenty-seven endoscopic endonasal dacryocystorhinostomies were performed in children 2 to 12 years of age for nasolacrimal duct obstruction. Previous probings in all patients were unsuccessful. The technique employed uncinectomy and a small lacrimal sac opening. Follow-up time was 3 months.

RESULTS

Twenty-one surgeries (77,8%) were successful. The only complication was silicone prolapse in one case.

CONCLUSION

Our results confirm endoscopic endonasal dacryocystorhinostomy as an acceptable and safe method for treating children with nasolacrimal duct obstructions that are resistant to probings.

Endoscopic-assisted probing for congenital nasolacrimal duct obstruction

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.

Comparison of Monocanalicular Stenting and Balloon Dacryoplasty in Secondary Treatment of Congenital Nasolacrimal Duct Obstruction After Failed Primary Probing

PURPOSE

To determine the success of monocanalicular stenting and balloon dacryoplasty as secondary treatment options for congenital nasolacrimal duct obstruction after failed probing surgery.

METHODS

An interventional case series of consecutive secondary balloon dacryoplasty and monocanalicular stenting for congenital nasolacrimal duct obstruction was reviewed. These secondary treatments were used in cases in which a bicanalicular stent would have been used in the past. Seventy-seven nasolacrimal systems in children with epiphora after probing and irrigation surgery were treated with a monocanalicular stent or balloon dacryoplasty. The patients were then evaluated at least 3 months after surgery or after stent removal by using a dye disappearance test. Cases in which there was no significant dye at 5 minutes were considered a success. Cases with residual dye or history of persistent tearing were considered failures.

RESULTS

The monocanalicular stent was used in 35 nasolacrimal systems, whereas balloon dacryoplasty was used in 42 nasolacrimal ducts. The mean age of treatment was 25.2 months for the monocanalicular stent group and 25.8 months for the balloon group. Overall, 32 of 35 (91%) nasolacrimal ducts responded to monocanalicular stenting, whereas 36 of 42 (86%) responded to balloon treatment. When the patient group was further stratified by age, the monocanalicular stenting was 94% successful in children younger than age 2 years and 89% successful for children older than 2 years. The balloon treatment had a success rate of 91% in the younger group and 79% in the older group. Chi-square statistical analysis showed no significant difference between the two treatments or on the basis of age stratification within each treatment group.

CONCLUSIONS

Monocanalicular stenting and balloon dacryoplasty are excellent secondary therapies for congenital nasolacrimal duct obstruction after initial probing and irrigation surgery has failed. These two treatment options are now our procedures of choice for secondary surgery.

Endoscopic treatment of intranasal abnormalities associated with nasolacrimal duct obstruction

PURPOSE

To report the incidence of intranasal abnormalities in children with nasolacrimal duct (NLD) obstruction and the results of treatment, which included nasal endoscopic removal of abnormal tissue.

METHODS

Nasal endoscopy was performed prospectively in 22 infants with mucoceles; in 97 children > or = 18 months at the time of initial NLD probing; and in 59 children with persistent NLD obstruction after previous probing. Endoscopic removal of abnormal tissue was performed in addition to NLD probing or balloon-catheter dilation.

RESULTS

NLD cysts were found in 22 of 22 (100%) infants with mucoceles. Cysts or other abnormalities of the distal duct were found in 6 of 97 (6.2%) children > or = 18 months at the time of initial probing and in 5 of 59 (8.5%) children whose previous NLD probing was unsuccessful. Surgery was successful in 91% of patients.

CONCLUSION

Nasal endoscopy identified intranasal anatomic abnormalities of the distal nasolacrimal duct uniformly in infants with mucoceles and in 6% to 9% of older children with complicated NLD obstruction. Treatment, including endoscopic removal of abnormal tissue, was successful in most patients. The use of nasal endoscopy may improve the treatment of patients with these disorders.

Late and very late initial probing for congenital nasolacrimal duct obstruction: what is the cause of failure?

AIMS

To find the cure rate of late (second year of age) and very late (3-5 years of age) initial probing for congenital nasolacrimal duct obstruction (CNLDO) and to identify the factors contributing to the failure rate of the probing in older children.

METHODS

In a prospective interventional case series study, 169 eyes of 125 consecutive patients (1-5 years old) with CNLDO underwent probing under general anaesthesia. Cure was defined as absence of tearing and discharge in the affected eye.

RESULTS

138 eyes of 101 patients aged 13-60 months (mean 23.4 (SD 10.2)) were included. Of 15 eyes (10.8%) with complex CNLDO, 80% presented after 24 months of age (p<0.0001). The cure rate was 89% in patients 13-24 months of age and 72% after the age of 24 months (p = 0.01). It was 90.2% in the membranous and 33.3% in the complex CNLDO in both late and very late probing (p<0.0001). There was a high correlation (r = 0.97) and no significant difference between the cure rate at 1 week and final follow up.

CONCLUSION

Accumulation of the complex CNLDO is the main risk factor for failure of probing in the older children. The outcome of the nasolacrimal duct probing at 1 week follow up is highly indicative of the final outcome.

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

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).

Dilation probing as primary treatment for congenital nasolacrimal duct obstruction

PURPOSE

Recent studies have suggested that simple nasolacrimal duct (NLD) probing can be an effective primary surgery for congenital NLD obstruction regardless of age. The success of balloon dilation after failed NLD probing suggests that maximally enlarging the passage through the NLD system may enhance the success of simple NLD probing. This study used sequential probing with modified, taper-tip probes to evaluate whether maximally enlarging the nasolacrimal duct can effectively treat congenital NLD obstructions in all age groups.

METHODS

Under general anesthesia, each obstructed NLD system was sequentially probed with larger diameter NLD probes until firm resistance prevented the passage of any larger probe size. Successful treatment was defined as a negative dye-disappearance test 2 weeks after probing and the absence of tearing symptoms at last contact.

RESULTS

A retrospective chart review identified 40 patients ages 6 to 32 months (average, 17.7 months) who underwent the sequential probing procedure. Sequential NLD probing was successful in 66 (92%) of 72 eyes. Of the failures, both eyes in a 15-month-old patient with Down's syndrome had tight, anomalous NLD systems. In the remaining 4 eyes, 2 had resolution of symptoms but partially positive dye-disappearance tests, and 2 underwent successful repeat sequential NLD probing. Subdividing by age, 27 (100%) of 27 obstructed NLD systems were treated successfully in patients older than 18 months compared with 39 (87%) of 45 in younger patients.

CONCLUSIONS

Sequential NLD probing to maximally enlarge the NLD system has a high rate of success in all children. Age does not appear to have an impact on success of probing.

Success of balloon catheter dilatation as a primary or secondary procedure for congenital nasolacrimal duct obstruction

PURPOSE

To determine the efficacy of lacrimal balloon catheter dilatation in treating congenital nasolacrimal duct obstruction (CNLDO) as a primary procedure in children more than 18 months of age and in children who have failed lacrimal probing or silicone intubation.

DESIGN

Retrospective, interventional case series.

PARTICIPANTS

Fifty-nine patients, ranging in age from 15 months to 9 years (mean, 35.6 months), with 73 lacrimal systems diagnosed with CNLDO who underwent nasolacrimal balloon catheter dilatation. Thirty-four lacrimal systems (46.5%) had no previous procedures, whereas 39 lacrimal systems (53.5%) had failed probing, silicone intubation, or both.

INTERVENTION

Balloon catheter dilatation was performed following standard protocol, with a simplified regimen in most patients.

MAIN OUTCOME MEASURES

Clinical patency of the nasolacrimal duct after balloon dilatation was the main outcome measure and was defined as complete resolution of signs and symptoms (crusting, discharge, and increased tear meniscus). Age, inferior turbinate infracture, and Downe's syndrome as related to the main outcome measure were also analyzed.

RESULTS

Overall, 56 of the 73 lacrimal systems (76.7%) had complete resolution of symptoms. Twenty-seven of all 34 primary balloon catheter dilatations (79.4%) remained clinically patent, whereas 29 of all 39 secondary balloon catheter dilatations (74.4%) remained clinically patent after surgery (P = 0.8165). Thirty-nine of 47 lacrimal systems (82.9%) in children older than 24 months remained clinically patent, whereas 17 of 26 lacrimal systems (65.4%) in children younger than 24 months remained clinically patent (P = 0.1573). The mean age of patients with successful outcomes was 37 months, whereas the mean age of patients with failed balloon catheter dilatations was 32 months (P = 0.3924). In the secondary procedure group, analysis showed that the mean age of success (32 months) was greater than the mean age of failure (18 months; P = 0.0491). Within the secondary group, 16 of 17 lacrimal systems (94.1%) older than 24 months were successful, whereas 13 of 22 lacrimal systems (59.1%) younger than 24 months were successful (P = 0.0344).

CONCLUSIONS

Balloon catheter dilatation is an effective treatment for congenital nasolacrimal duct obstruction. In particular, balloon catheter dilatation in older children who failed previous probing is highly successful.

Balloon catheter dilation for treatment of persistent nasolacrimal duct obstruction

PURPOSE

To report the outcome of balloon catheter dilation of the lacrimal duct for treatment of children with persistent nasolacrimal duct obstruction after previous surgery.

DESIGN

Interventional case series.

METHODS

Thirty-two consecutive children with a history of persistent nasolacrimal duct obstruction following previous surgery were treated with nasolacrimal duct probing with balloon catheter dilation of the distal nasolacrimal duct. Patients were excluded from this study if they had a history of facial trauma, systemic disorders that involved the lacrimal system, or nasolacrimal duct cysts. Outcomes were considered excellent if the patient had complete symptomatic resolution of epiphora and dacryocystitis and normal tear drainage on examination, good if the patient had only minimal residual symptoms or a minimally delayed dye disappearance test, fair if the patient had moderate residual symptoms or delayed tear drainage, and poor if there was no improvement.

RESULTS

Thirty-two children (20 with bilateral nasolacrimal duct obstruction and 12 with unilateral nasolacrimal duct obstruction) underwent balloon catheter dilation. Overall results were excellent in 9 (28%) patients, good in 15 (47%) patients, fair in 7 (22%) patients, and poor in 1 (3%) patient. Seven patients had undergone more than one previous procedure. Of these patients, 3 had excellent outcomes, 2 had good outcomes, 1 had a fair outcome, and 1 had a poor outcome following balloon catheter dilation.

CONCLUSIONS

Balloon catheter dilation is a safe and generally effective treatment for children with persistent symptoms of nasolacrimal duct obstruction following previous surgery.

Comparison of balloon dacryocystoplasty to probing as the primary treatment of congenital nasolacrimal duct obstruction

PURPOSE

In children older than 18 months, primary probing procedures for congenital nasolacrimal duct obstruction (CNLDO) are thought to have lower rates of success. This study compares the results of primary probing to balloon dacryocystoplasty (DCP) in children stratified by age category.

METHODS

In a retrospective chart review, 29 eyes with CNLDO that underwent balloon DCP in children older than 18 months were identified and age-matched to 29 eyes that underwent probing. The eyes were divided into 3 age categories: category 1 (18-24 months), category 2 (24-36 months), and category 3 (>36 months).

RESULTS

Of the 29 eyes treated with balloon DCP (mean age, 37.1 months), 26 were successfully treated. Twenty-five of the 29 matched probed eyes (mean age, 31.1 months) were successfully treated, resulting in an overall success rate of 90% for balloon DCP and 86% for primary probing. Within each age category, the success rate varied but did not show an advantage to balloon DCP. The presence of crusting and expressible discharge from the puncta during preoperative evaluation predicted a successful probing (OR, 16; 95% CI, 1.3-192).

CONCLUSION

Overall, balloon DCP did not appear to present an advantage as compared with primary probing as the initial treatment in these children. Primary probing has an impressive overall success rate that did not diminish in the children older than 36 months.

Treatment of nasolacrimal duct obstruction in children with trisomy 21

BACKGROUND

Nasolacrimal duct (NLD) obstruction and tear film abnormalities occur frequently in children with trisomy 21. This study describes the outcomes of treatment for NLD obstruction in this population.

METHODS

The records of 15 children with trisomy 21 treated for NLD obstruction were reviewed. Eight patients were initially treated with NLD probing with or without placement of nonfixated lacrimal stents. Because of poor success with this procedure, the initial treatment of children with trisomy 21 and NLD obstruction was changed to balloon catheter dilation in 1997. Outcomes were considered excellent if the patient had complete resolution of epiphora and dacryocystitis, good if the patient had only mild residual symptoms, fair if the patient had significant residual symptoms, and poor if there was no improvement.

RESULTS

Of 8 patients treated initially with NLD probing, 5 had fair or poor outcomes. These patients all had good outcomes after placement of nasally fixated lacrimal stents, balloon catheter dilation, or both. Of 7 patients treated initially with balloon catheter dilation, 5 had excellent or good outcomes and 2 had fair or poor outcomes.

CONCLUSION

Simple NLD probing is often unsuccessful in treating NLD obstruction in children with trisomy 21. Balloon catheter dilation appears to be a reasonable alternative first treatment in these patients.