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Alruwaili R, Alanazi F, Alrashidi A, Hazazi M, Alenezi M. Comparative Analysis of Silicone Tube Intubation Versus Probing and Balloon Dilation for Congenital Nasolacrimal Duct Obstruction: A Systematic Review and Meta-Analysis. J Craniofac Surg 2024; 35:1114-1119. [PMID: 38727216 DOI: 10.1097/scs.0000000000010273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/13/2024] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVE Congenital nasolacrimal duct obstruction (CNLDO) is a pediatric disorder with a wide range of pathology. If untreated, the condition may end up with serious complications. Multiple treatment options for CNLDO exist throughout the literature, and there is an ongoing debate on the best intervention for each disease subgroup and the best timing of such interventions. This study compares the success and failure rates of silicone tube intubation (STI) against probing and balloon dilation (BD). METHODS The authors searched the literature for relevant articles using PubMed, Scopus, web of Science, and Cochrane Library until January 2024. Using RevMan 5.4, the authors compared STI's success and failure rates to probing and BD using risk ratios (RRs) and a random-effect model. In addition, the complication rate of monocanalicular intubation (MCI) versus bicanalicular intubation (BCI) was investigated. The authors used the leave-one-out method to check for influential studies and to resolve heterogeneity. RESULTS The screening process resulted in 23 eligible articles for inclusion in the authors' review. Silicone tube intubation had a higher chance of resolving the symptoms of CNLDO than probing (RR = 1.11; 95% CI: 1.04, 1.20; P = 0.004) while having less risk of surgical failure (RR = 0.48; 95% CI: 0.30, 0.76; P = 0.002]. Monocanalicular intubation showed no statistically significant difference when compared with BCI in terms of surgical success and failure; however, MCI had a lower risk of complications (RR = 0.68; 95% CI: 0.48, 0.97; P = 0.04). In addition, STI did not demonstrate any significant difference from BD. CONCLUSION There was no significant difference in success/failure between MCI and BCI; monocanalicular had fewer complications. Silicone tube intubation did better in terms of surgical success than probing, especially in children over 12 months, suggesting that it is the preferred intervention for older patients with CNLDO.
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Affiliation(s)
- Rahaf Alruwaili
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh
- Department of Ophthalmology, King Abdulaziz Specialist Hospital
| | - Farhan Alanazi
- Department of Otolaryngology-Head and Neck Surgery, Prince Mohammed Medical City, Jouf
| | - Ali Alrashidi
- Department of Otolaryngology-Head and Neck Surgery, King Salman Specialist Hospital, Hail
| | - Mohammed Hazazi
- Department of Otolaryngology-Head and Neck Surgery, Prince Sultan Medical Military City, Riyadh
| | - Mazyad Alenezi
- Department of Otolaryngology-Head and Neck Surgery, Collage of Medicine, Qassim University, Buriyadh, Qassim, Kingdom of Saudi Arabia
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Ueta Y, Watanabe Y, Kamada R, Tanaka N. Assessment of Office-Based Probing with Dacryoendoscopy for Treatment of Congenital Nasolacrimal Duct Obstruction: A Retrospective Study. J Clin Med 2023; 12:7048. [PMID: 38002662 PMCID: PMC10672542 DOI: 10.3390/jcm12227048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/31/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
We aimed to evaluate the safety and efficacy of office-based probing with dacryoendoscopy under local anesthesia for congenital nasolacrimal duct obstruction (CNLDO). This single-institution study retrospectively reviewed data on 72 eyes of 64 consecutive children (38 boys, 43 eyes; 26 girls, 29 eyes), aged between 6 and 17 (mean age: 10.0 ± 2.7) months with suspected CNLDO, from July 2016 to February 2022. These patients underwent probing with dacryoendoscopy under local anesthesia. CNLDO was diagnosed clinically based on the presence of epiphora and sticky eyes due to mucous discharge commencing within the first 3 months of life, increased tear meniscus height, and fluorescein dye disappearance test results. A total of 63 of the 72 eyes had narrowly defined CNLDO, and 9 eyes had other types of obstructions. The intervention success rate was 100% (63/63 eyes) for patients with typical CNLDO and 97.2% (70/72 eyes) for the entire study cohort. Moreover, CNLDO was classified into five types based on the features of the distal end of the nasolacrimal duct. Probing with dacryoendoscopy is safe and yields a high success rate in pediatric patients with CNLDO. This is the first study to assess the safety and efficacy of probing with dacryoendoscopy under local anesthesia in pediatric patients with CNLDO.
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Affiliation(s)
- Yoshiki Ueta
- Department of Ophthalmology, Shinseikai Toyama Hospital, 89-10 Shimowaka, Imizu 939-0243, Toyama, Japan
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Oke I, Elze T, Miller JW, Lorch AC, Hunter DG, Elliott AT. Factors Associated With Nasolacrimal Duct Probing Failure Among Children in the Intelligent Research in Sight Registry. JAMA Ophthalmol 2023; 141:342-348. [PMID: 36862386 PMCID: PMC9982738 DOI: 10.1001/jamaophthalmol.2023.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/28/2022] [Indexed: 03/03/2023]
Abstract
Importance Understanding the factors associated with nasolacrimal duct probing failure in young children may help inform practice patterns. Objective To identify factors associated with repeated nasolacrimal duct probing in young children. Design, Setting, and Participants This retrospective cohort study analyzed data from the Intelligent Research in Sight (IRIS) Registry for all children who underwent nasolacrimal duct probing before 4 years of age between January 1, 2013, and December 31, 2020. Main Outcomes and Measures The Kaplan-Meier estimator was used to assess the cumulative incidence of a repeated procedure within 2 years of the initial procedure. Hazard ratios (HRs) derived from multivariable Cox proportional hazards regression models were used to evaluate the association between repeated probing and patient age, sex, race and ethnicity, geographic region, operative side, laterality of obstruction, type of initial procedure, and surgeon volume. Results This study included 19 357 children (9823 [50.7%] male; mean [SD] age, 1.40 [0.74] years) undergoing nasolacrimal duct probing. The cumulative incidence of repeated nasolacrimal duct probing was 7.2% (95% CI, 6.8%-7.5%) within 2 years of the initial procedure. Among 1333 repeated procedures, the second procedure involved silicone intubation in 669 (50.2%) and balloon catheter dilation in 256 (19.2%). Among 12 008 children aged 1 year or younger, office-based simple probing was associated with a slightly higher probability of reoperation compared with facility-based simple probing (9.5% [95% CI, 8.2%-10.8%] vs 7.1% [95% CI, 6.5%-7.7%]; P < .001). In the multivariable model, a greater risk of repeated probing was associated with bilateral obstruction (HR, 1.48; 95% CI, 1.32-1.65; P < .001) and office-based simple probing (HR, 1.33; 95% CI, 1.13-1.55; P < .001), and a lower risk was associated with primary balloon catheter dilation (HR, 0.69; 95% CI, 0.56-0.85; P < .001) and procedures performed by high-volume surgeons (HR, 0.84; 95% CI, 0.73-0.97; P = .02). Age, sex, race and ethnicity, geographic region, and operative side were not associated with reoperation risk in the multivariable model. Conclusions and Relevance In this cohort study, most children in the IRIS Registry undergoing nasolacrimal duct probing before 4 years of age did not require any additional intervention. Factors associated with lower risk of reoperation include surgeon experience, probing performed under anesthesia, and primary balloon catheter dilation.
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Tobias Elze
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Joan W. Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Alice C. Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - David G. Hunter
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Alexandra T. Elliott
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
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Lee C, Jeong SM, Kim GJ, Joo EY, Song MH, Sa HS. Efficacy and Safety of Inhalation Sedation during Office Probing for Congenital Nasolacrimal Duct Obstruction. J Clin Med 2021; 10:jcm10081800. [PMID: 33924278 PMCID: PMC8074913 DOI: 10.3390/jcm10081800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
We compared the effectiveness of inhaled sevoflurane versus physical restraint during probing in children with congenital nasolacrimal duct obstruction (CNLDO). We performed a retrospective review of children with CNLDO who underwent office probing procedures by a single surgeon under sedation or restraint. Patients’ characteristics at the time of probing, including age, sex, laterality, previous non-surgical treatment, presence of dacryocystitis, outcomes of probing, and complications were compared between the sedation and restraint groups. A multivariable logistic regression analysis was performed to investigate the prognostic factors associated with the success of probing. A subgroup analysis by 12 months of age was also conducted. The overall success rate was 88.6% in 202 eyes of 180 consecutive children (mean age, 15.1 ± 7.7 months). The sedation group had a marginally higher success rates than the restraint group (93.8% vs. 85.1%, p = 0.056). The success rate was not significantly different between the two groups in children aged <12 months (90.9% vs. 93.1%, p = 0.739), but it was significantly higher in the sedation group (94.7% vs. 77.8%. p = 0.006) in children aged ≥12 months. Inhalation sedation was the most potent factor associated with success (adjusted odds ratio = 5.56, 95% confidence interval = 1.33–23.13, p = 0.018) in children aged ≥12 months. There were no surgical or sedation-related complications intra- and postoperatively. Inhaled sevoflurane sedation resulted in more successful, controlled, painless probing, particularly in children aged ≥12 months. It represents a safe, efficient alternative to general anesthesia.
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Affiliation(s)
- Chunghyun Lee
- Department of Ophthalmology, Gangneung Asan Hospital, Gangneung 25440, Korea;
| | - Su-Min Jeong
- Department of Family Medicine, Samsung Medical Center, Seoul 06351, Korea;
| | - Gye Jung Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Eun-Young Joo
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (E.-Y.J.); (M.H.S.)
| | - Myung Hee Song
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (E.-Y.J.); (M.H.S.)
| | - Ho-Seok Sa
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
- Correspondence: ; Tel.: +82-2-3010-3680; Fax: +82-2-470-6440
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Li Y, Wei M, Liu X, Zhang L, Song X, Xiao C. Dacryoendoscopy-assisted incision of Hasner's valve under nasoendoscopy for membranous congenital nasolacrimal duct obstruction after probing failure: a retrospective study. BMC Ophthalmol 2021; 21:182. [PMID: 33866971 PMCID: PMC8054357 DOI: 10.1186/s12886-021-01948-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022] Open
Abstract
Background To introduce a treatment option: dacryoendoscopy-assisted incision of Hasner’s valve under nasoendoscopy and assess its efficacy in treating membranous congenital nasolacrimal duct obstruction (CNLDO) in children older than 1 year with history of initial probing failure. Methods 52 eyes of 43 children with membranous CNLDO who underwent dacryoendoscopy-assisted incision of Hasner’s valve under nasoendoscopy between May 2012 and October 2020 were enrolled in this retrospective study. All participants were older than 1 year and all the eyes had gone through probing at least once but still had symptoms of epiphora and discharge. Surgical success was defined as a normal fluorescein dye disappearance test (FDDT) and the absence of pre-operation complaints, including epiphora, muco-purulent discharge, increased tear lake or the symptoms of acute infection such as acute dacryocystitis. Patients’ demographics, clinical features and follow-up outcomes were evaluated. Results Of all these operated cases, surgical success was achieved in 52/52 eyes without any early or late complications. The overall success rate was 100%. Conclusions Dacryoendoscopy-assisted incision of Hasner’s valve under nasoendoscopy is an effective and minimally invasive surgical treatment in membranous CNLDO patients with initial probing failure.
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Affiliation(s)
- Yue Li
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Min Wei
- Handan Eye Hospital, Handan City, Hebei Province, China
| | - Xueru Liu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Leilei Zhang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xuefei Song
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Caiwen Xiao
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
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Success rates of probing for congenital nasolacrimal duct obstruction at various ages. BMC Ophthalmol 2020; 20:403. [PMID: 33032542 PMCID: PMC7542772 DOI: 10.1186/s12886-020-01658-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although nasolacrimal duct probing is the standard treatment for congenital nasolacrimal duct obstruction (CNLDO) among children, the optimal timing of this procedure has been a topic of debate. The aim of the study was to analyze the clinical efficacy of nasolacrimal duct probing among patients with CNLDO symptoms at various ages. METHODS An 8-year retrospective study involved 2434 patients (3009 eyes), who underwent nasolacrimal duct probing conducted under topical anesthesia in the operating theatre. The study group consisted of 1148 girls (47.2%) and 1286 boys (52.8%) from 2 weeks to 41 months (average age was 8 ± 5.6 months). The participants were divided into nine age groups: 0-2 months, 3-6 months, 7-9 months, 10-12 months, 13-15 months, 16-18 months, 19-21 months, 22-24 months and over 24 months. RESULTS Bilateral obstruction was present among 575 (23.6%) children and was associated with a higher percentage of unsuccessful procedures compared to patients with unilateral obstruction (16.9% vs 10.2%, p < 0.001 Chi-square test). The success rate of the initial probing was 87.2% for all children and it was shown that it decreased with age. In the above age groups, it was 87.9%; 91.4%; 89.6%; 86%; 76.3%; 71.3%; 70.3%; 70.2%; 65.4%, respectively. CONCLUSIONS Probing is a safe and effective procedure. However, age at the time of the initial intervention and bilateral surgery constitute significant risk factors for failed probing. Probing between 7 and 9 months appears to be reasonable treatment strategy for children without recurrent infections. Early surgical intervention may be considered for patients with additional signs.
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Golash V, Kaur H, Athwal S, Chakartash R, Laginaf M, Khandwala M. Management of congenital nasolacrimal duct obstruction: results of a national survey of paediatric and oculoplastic ophthalmologists. Eye (Lond) 2020; 35:1930-1936. [PMID: 32939049 DOI: 10.1038/s41433-020-01183-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To survey variation in management of congenital nasolacrimal duct obstruction (CNLDO) by oculoplastic and paediatric ophthalmologists in the UK. METHODS A 14-question online survey was sent to all members of the British Oculoplastic Surgery Society (BOPSS) and the British and Irish Paediatric Ophthalmology and Strabismus Association (BIPOSA) in February 2020. The aim was to establish preferred primary, secondary and tertiary interventions for CNLDO treatment, with emphasis on the use of nasoendoscopy and ductal intubation. Results were compared with a national survey from 2007 to observe trends in management. RESULTS One hundred and three responses from single-speciality consultants were analysed. In total, 71.8% of CNLDO patients were assessed by paediatric ophthalmologists. Fluorescein dye disappearance test was the commonest investigation, and paediatric consultants were five times more likely to perform Jones test. No clinicians performed outpatient probing. Age of first intervention was most commonly 12 months, although more interventions are being conducted at younger ages than in 2007. Preferred primary procedure for both subspecialties was syringe and probe under general anaesthetic, with 43.9% of oculoplastic consultants using nasoendoscopy vs 12.9% of paediatric consultants. Most common re-do procedure for both subspecialties was nasoendoscopy-guided syringe and probe ± intubation. In contrast to 2007, dacryocystorhinostomy is now the commonest tertiary procedure, with endonasal approach twice as common as external. CONCLUSION Despite changes in approach since 2007, there is still considerable variation between oculoplastic and paediatric ophthalmologists regarding treatment preferences for CNLDO, particularly the use of nasoendoscopy. We propose a national audit of CNLDO treatment outcomes to potentially standardise treatment protocols.
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Affiliation(s)
| | | | - Sarju Athwal
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK.
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Xiang Q, Gao X, Chen X, Qi J, Fang J. Nasolacrimal Duct Probing for Young Children With Congenital Nasolacrimal Duct Obstructions in China: A 10-Year Systematic Review. J Pediatr Ophthalmol Strabismus 2019; 56:365-372. [PMID: 31743404 DOI: 10.3928/01913913-20190923-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/30/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the success rate of probing for young children with nasolacrimal duct obstructions and the risk factors involved. METHODS The medical records of 3,143 patients (3,928 eyes) who received nasolacrimal duct probing in southwest China were collected. These included delivery method, age and gender, preoperative treatments, anesthesia methods, probing procedure, and follow-up clinical records. Then the relationship between the success rates of the probing and a few probable risk factors were analyzed. RESULTS Children delivered by eutocia were more likely than those delivered by cesarean section to have nasolacrimal duct obstruction. The total success rate of the probing was 85.2%. Patients older than 19 months had a lower completion rate compared with those younger than 1 year (P < .01). In the follow-up observations, the younger age groups were more likely to have higher success rates than the older ones (P < .05) using pairwise comparison. The success rates also had a significant relationship with the type of obstruction and older patients were more likely to have complex obstruction (odds ratio: 1.13, 95% confidence interval: 1.08 to 1.19, P < .001). CONCLUSIONS This large-scale study proved several factors affect the success rate of nasolacrimal duct probing, and confirmed children delivered by eutocia were more likely to have nasolacrimal duct obstruction. [J Pediatr Ophthalmol Strabismus. 2019;56(6):365-372.].
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Bach A, Vanner EA, Warman R. Efficacy of Office-Based Nasolacrimal Duct Probing. J Pediatr Ophthalmol Strabismus 2019; 56:50-54. [PMID: 30371916 DOI: 10.3928/01913913-20180925-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 08/03/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the efficacy of nasolacrimal duct probing conducted in the office for nasolacrimal duct obstruction. METHODS A retrospective chart review was conducted of 1,294 patients. Of those, 1,227 patients who underwent office-based nasolacrimal probings of the nasolacrimal duct at a single tertiary care center were included. RESULTS A total of 82 (6.7%) patients needed reprobing. Of the 82 patients who underwent a second procedure, 35 (43%) underwent a second in-office probing with a success rate of 77%. The 8 (22%) patients who failed the second in-office probing underwent probing and Crawford stent placement in the operating room and their symptoms resolved. For the 47 (57%) patients who failed the primary in-office probing and underwent operating room probing and stent placement, only 1 (2%) needed a second operating room probing and stent placement. Logistic regression analyses indicated an increased likelihood of needing a secondary procedure with increased age at the time of the first probing. CONCLUSIONS This large, retrospective analysis of office-based probings demonstrated a success rate of 93.3% with increased likelihood of not needing a second procedure with probing at a younger age. This study demonstrates an excellent success rate for in-office probings for patients both younger and older than 12 months. This not only shows a high rate of efficacy, but is also highly cost efficient when compared to primary probing in the operating room. [J Pediatr Ophthalmol Strabismus. 2019;56(1):50-54.].
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Congenital Nasolacrimal Duct Obstruction (CNLDO): A Review. Diseases 2018; 6:diseases6040096. [PMID: 30360371 PMCID: PMC6313586 DOI: 10.3390/diseases6040096] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 12/03/2022] Open
Abstract
Congenital nasolacrimal duct obstruction (CNLDO) is a common condition causing excessive tearing or mucoid discharge from the eyes, due to blockage of the nasolacrimal duct system. Nasolacrimal duct obstruction affects as many as 20% children aged <1 year worldwide and is often resolved without surgery. Available treatment options are conservative therapy, including observation, lacrimal sac massage and antibiotics, and invasive therapy. Observation, combined with conservative options, seems to be the best option in infants aged <1 year. Meanwhile, in children aged >1 year, nasolacrimal probing successfully addresses most obstructions. However, the most favorable timing for probing remains controversial. To alleviate persistent epiphora and mucous drainage that is refractory to probing, repeat probing, silicone tube intubation, balloon catheter dilation or dacryocystorhinostomy can be considered as available treatment options. Our review aims to provide an update to CNDO management protocols.
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Galindo-Ferreiro A, Khandekar R, Akaishi PM, Cruz A, Gálvez-Ruiz A, Dolmetsch A, Schellini S. Success Rates of Endoscopic-Assisted Probing Compared to Conventional Probing in Children 48 Months or Older. Semin Ophthalmol 2017; 33:435-442. [PMID: 29069710 DOI: 10.1080/08820538.2017.1284872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND To evaluate the success rates of endoscopic-assisted probing compared to conventional probing in children 48 months or older. METHODS This retrospective study included children 48 months and older with CNLDO who underwent endoscopic-assisted probing or conventional probing between January 2011 to August 2015 at a tertiary eye care hospital in central Saudi Arabia. Probing was considered successful when signals of tearing or discharge disappeared and fluorescein dye disappearance test (FDDT) was normal. Demographic data, clinical features, intraoperative and postoperative variables were correlated to the success rate. RESULTS One hundred and twelve children with CNLDO undergoing endoscopic-assisted (37 patients) or conventional (75 patients) probing were included. The success rates of endoscopic-assisted and conventional probing were 94.6% [95% confidence interval (CI): 89.5-99.7] and 58.7% [95% (CI): 47.6-69.8], respectively. The success rate was higher with endoscopic probing, especially in older children. CONCLUSIONS Endoscopic-assisted probing can achieve better outcomes to treat CNLDO, even in older children. The significantly higher success rates with endoscopic probing are likely due to the ability to observe and treat associated problems.
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Affiliation(s)
| | - Rajiv Khandekar
- b Department of Ophthalmology , King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia
| | - Patricia Mitiko Akaishi
- c Department of Ophthalmology , Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto-University of São Paulo , Brazil
| | - Augusto Cruz
- c Department of Ophthalmology , Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto-University of São Paulo , Brazil
| | - Alberto Gálvez-Ruiz
- b Department of Ophthalmology , King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia
| | | | - Silvana Schellini
- b Department of Ophthalmology , King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia.,e Department of Ophthalmology Faculdade de Medicina de Botucatu - UNESP , São Paulo , Brasil
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Pediatric nasolacrimal duct obstruction-benefit of a combined therapeutic approach. World J Pediatr 2017; 13:427-432. [PMID: 28540695 DOI: 10.1007/s12519-017-0041-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/24/2015] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pediatric nasolacrimal duct obstruction (PNDO) requires therapeutic intervention after conservative procedures failed. As resilient treatment guidelines for the treatment are missing, the aim of this study was to evaluate the advantages of two different intervention techniques in children with PNDO. METHODS Between January, 2006 and June, 2014, 233 children (0-208 months) were treated either with conventional probing by ophthalmologists only (Group I) or with endonasal endoscopic interdisciplinary approach (Group II). The clinical outcome was analyzed. RESULTS The overall success rate of Group I was 93.4% compared to 98.4% of Group II (P<0.05). 50% of all interventions (n=62) of Group II required further surgical procedures in addition to probing/irrigation, particularly with regard to children <6 and >24 months. CONCLUSIONS Endoscopic control in treatment of PNDO allows exact identification of the stenosis and appropriate surgical intervention with an improved clinical outcome. Endonasal endoscopic surgical techniques should be the standard PNDO treatment.
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A Case Series of Dacryoendoscopy in Childhood: A Diagnostic and Therapeutic Alternative for Complex Congenital Nasolacrimal Duct Obstruction Even in the First Year of Life. Adv Ther 2017; 34:1221-1232. [PMID: 28341931 DOI: 10.1007/s12325-017-0517-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Congenital nasolacrimal duct obstruction (CNLDO) is the most common cause of epiphora in infancy. Spontaneous resolution occurs in the majority of the cases by 1 year of age. Nevertheless, obstruction has a negative impact on the outcome of conservative or surgical therapy, especially in cases of complex CNLDO. When the condition persists beyond several months, early intervention with dacryoendoscopy (DE) around the age of 1 year could yield good results. The objective of the study is to analyze the success rate and effectiveness of early DE for complex CNLDO in the first year of life. METHODS A retrospective, non-comparative case series is presented. DE was performed under general anesthesia in patients between the age of 1 and 12 months with severe recurrent acute or chronic dacryocystitis. The medical histories, intraoperative and postoperative results after 3 months as well as via parents' interviews were analyzed to investigate the success rate. RESULTS A total of 18 consecutive DE in 16 patients between the age of 1 and 12 months (mean 7.3 ± 3.4 months) were studied. Nine lacrimal ducts were diagnosed with persistent chronic dacryocystitis refractory to probing/syringing. The remaining 9 presented recurrent acute dacryocystitis. Diagnostic DE was performed in 18 cases. A therapeutic DE was conducted in 15 lacrimal ducts (83.3%) with simultaneous correction of the associated stenosiswith the tip of the endoscope. A visual controlled opening of the stenosis was impossible in 3 cases due to a too narrow presaccal anatomy (n = 1), an osseous duct stenosis (n = 1), and a bulging membrane of Hasner into the inferior nasal meatus (n = 1). Postoperative findings were classified into four categories: poor, fair, good and excellent. Good results were documented in 16.7% (n = 3) and excellent results in 77.7% (n = 14). The bony obstruction was treated with dacryocystorhinostomy. A minimum follow-up of 3 months was considered for final clinical analysis. Ten patients' parents (12 surgeries) were interviewed by telephone (mean follow-up 24.8 months). No recurrence of stenosis and no further postoperative complications were observed. CONCLUSION DE is a diagnostic and therapeutic option for complex CNLDO in patients before the age of 1 year. The outcome of DE in the 3 months follow-up is highly indicative of positive final results in terms of patency of the lacrimal duct.
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Kothari M, Rathod V, Shah K, Shikhangi K, Singhania R. Congenital nasolacrimal duct obstruction: Should we continue lacrimal massage till 1 year or perform an office probing at 6 months? A clinical decision analysis approach. Indian J Ophthalmol 2017; 65:167-169. [PMID: 28345576 PMCID: PMC5381299 DOI: 10.4103/ijo.ijo_245_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Mihir Kothari
- Department of Pediatric Oculoplasty Services, Jyotirmay Eye Clinic and Ocular Motility Laboratory, Thane; Department of Pediatric Ophthalmology, Mahatme Eye Hospital, Nagpur, Maharashtra, India
| | - Vivek Rathod
- Department of Pediatric Oculoplasty Services, Jyotirmay Eye Clinic and Ocular Motility Laboratory, Thane, Maharashtra, India
| | - Kruti Shah
- Department of Pediatric Oculoplasty Services, Jyotirmay Eye Clinic and Ocular Motility Laboratory, Thane, Maharashtra, India
| | - Khushboo Shikhangi
- Department of Pediatric Oculoplasty Services, Jyotirmay Eye Clinic and Ocular Motility Laboratory, Thane, Maharashtra, India
| | - Renu Singhania
- Department of Pediatric Oculoplasty Services, Jyotirmay Eye Clinic and Ocular Motility Laboratory, Thane, Maharashtra, India
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Rajabi MT, Zavarzadeh N, Mahmoudi A, Johari MK, Hosseini SS, Abrishami Y, Rajabi MB. Bicanalicular versus monocanalicular intubation after failed probing in congenital nasolacrimal duct obstruction. Int J Ophthalmol 2016; 9:1466-1470. [PMID: 27803865 DOI: 10.18240/ijo.2016.10.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/15/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing. METHODS This retrospective study was performed on 338 patients with the diagnosis of congenital nasolacrimal duct obstruction with age 1-4y that had failed primary probing. Intubation was performed under light sedation in operating room and the stent was left 3mo in place. Clinical outcome was investigated 3mo after tube removal. RESULTS Bicanalicular intubation method had higher complete and relative success rates compared to monocanalicular intubation (P=0.00). In addition, Monoka intubation had better outcomes compared to Masterka technique (P=0.046). No difference was found between genders but the higher the age, the better the outcomes with bicanalicular technique rather than monocanalicular. CONCLUSION Overall success rate of bicanalicular intubation is superior to monocanalicular technique especially in older ages. Also, based upon our clinical outcomes, Masterka intubation is not recommended in cases of failed probing.
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Affiliation(s)
| | - Najmeh Zavarzadeh
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Alireza Mahmoudi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | | | | | - Yalda Abrishami
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
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Galindo-Ferreiro A, Akaishi P, Cruz A, Khandekar R, Dossari S, Dufaileej M, Galvez-Ruiz A, Schellini S. Success Rates of Conventional Versus Endoscope-Assisted Probing for Congenital Nasolacrimal Duct Obstruction in Children 12 Years and Younger. J Pediatr Ophthalmol Strabismus 2016; 53:292-9. [PMID: 27383144 DOI: 10.3928/01913913-20160610-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 04/05/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the success rates for congenital nasolacrimal duct obstruction (CNLDO) treated with conventional probing versus endoscope-assisted probing. METHODS A retrospective nonrandomized comparison of the success rates in children (0 to 12 years) with CNLDO who underwent conventional probing or endoscope-assisted probing. Success was defined as absence of tearing or negative fluorescein dye disappearance test. Stent was evaluated. RESULTS A total of 270 patients with CNLDO comprised the study population. The mean age was 37 months in the conventional probing group and 48.5 months in the endoscope-assisted probing group. The subjective and objective success rates were 76.1% and 75.9%, respectively, in the conventional probing group and 95.7% and 95.7%, respectively, in the endoscope-assisted probing group. The success rates were higher for both methods in the endoscope-assisted probing group (P < .005). The success rate decreased in older children in the conventional probing group (100% < 6 months; 62.5% > 48 months) and remained stable in the endoscope-assisted probing group (100% < 6 months; 97% > 48 months). Stent did not improve success. CONCLUSIONS Endoscope-assisted probing increased success in older children and children with bilateral obstruction. [J Pediatr Ophthalmol Strabismus. 2016;53(5):292-299.].
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Success rates of dacryoendoscopy-guided probing for recalcitrant congenital nasolacrimal duct obstruction. Jpn J Ophthalmol 2016; 60:274-9. [DOI: 10.1007/s10384-016-0445-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 02/17/2016] [Indexed: 10/21/2022]
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Hung CH, Chen YC, Lin SL, Chen WL. Nasolacrimal Duct Probing under Topical Anesthesia for Congenital Nasolacrimal Duct Obstruction in Taiwan. Pediatr Neonatol 2015; 56:402-7. [PMID: 26026949 DOI: 10.1016/j.pedneo.2015.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/30/2015] [Accepted: 04/09/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To report the success rates of office probing for congenital nasolacrimal duct obstruction (NLDO) among children of different age groups in Taiwan. METHODS In this single-center, retrospective study, 564 eyes of 477 patients under the age of 5 years diagnosed with congenital NLDO were treated in a stepwise manner between 2001 and 2013. For infants aged < 6 months, treatment with massage and observation was suggested, followed by deferred probing under topical anesthesia if symptoms persisted. However, in cases of severe infection, immediate probing was suggested. In children aged > 6 months, office probing was usually highly recommended. Those with probing failures received either a second probing or silicone intubation. Treatment success was defined as anatomic patency by immediate irrigation after probing and absence of epiphora or mucous discharge at the follow-up visit. RESULTS Primary probing was successful in 457 of 564 eyes (success rate: 81%). The success rate of primary probing was negatively correlated with increasing age: 90.1% (163/181), 79.6% (164/206), 76.8% (73/95), 73.5% (36/49), 75% (18/24), and 33% (3/9) for the age groups of 0 to <6 months, 6 to <12 months, 12 to <18 months, 18 to <24 months, 24 to <36 months, and 36-60 months, respectively (p < 0.001, Fisher's exact test). The second probing was successful in 52 of 81 eyes. In total, probing was successful in 509 of 564 eyes (success rate: 90.2%). CONCLUSION Office probing is safe and effective for treating congenital NLDO. The success rate of primary probing decreases significantly with age.
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Affiliation(s)
- Chih-Heng Hung
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan
| | - Yi-Chun Chen
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan
| | - Shun-Ling Lin
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan; Medical College, National Taiwan University, Taipei, Taiwan; Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wei-Lun Chen
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan
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Heichel J, Bachner F, Schmidt-Pokrzywniak A, Struck HG, Stuhlträger U, Bredehorn-Mayr T. [Treatment of congenital lacrimal duct obstruction: A prospective clinical cohort study]. Ophthalmologe 2015; 112:840-7. [PMID: 26070835 DOI: 10.1007/s00347-015-0067-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pressurized probing and irrigation is the method of choice for congenital lacrimal duct obstruction after conservative therapeutic strategies have failed. The aim of this study was to evaluate age dependence and success rates of different therapeutic options. MATERIAL AND METHODS A prospective cohort study of children with congenital lacrimal duct obstruction was performed. All children treated during the period between May 2009 and June 2010 were included. Surgical success was defined as the absence of epiphora and mucous discharge for a postoperative follow-up of 3 months. Odds ratios (OR) and 95 % confidence intervals (CI) of different variables were estimated using logistic regression. RESULTS A total of 111 children (137 eyes) underwent treatment for congenital lacrimal duct obstruction. The mean age of the children was 7.7 months (range 1-30 months). The success rate of probing under local anesthesia was 85.5 % (n = 100). Probing under general anesthesia without intubation of the lacrimal pathway was successful in 28.6 % (n = 2). Treatment under general anesthesia with intubation of the lacrimal pathway had a success rate of 94.2 %. If the primary treatment was complicated the OR was 1.9 (95 % CI: 0.7-5.1), for males the OR was 1.7 (95 % CI: 0.8-3.5) and in cases of a positive family history the OR was 1.5 (95 % CI: 0.7-3.3). With every increasing month of age the risk not to be treated successfully increased (OR: 1.3, 95 % CI: 1.2-1.5). CONCLUSION Syringing under local anesthesia is an effective therapy. The highest success rates were found at the ages of 1-6 months. Therapy with additional silicone tube intubation was highly successful.
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Affiliation(s)
- J Heichel
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
| | - F Bachner
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - A Schmidt-Pokrzywniak
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - H-G Struck
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - U Stuhlträger
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - T Bredehorn-Mayr
- Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
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Kim HC, Cho AR, Lew H. Dacryoscintigraphic findings in the children with tearing. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:1-6. [PMID: 25646054 PMCID: PMC4309863 DOI: 10.3341/kjo.2015.29.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 08/18/2014] [Indexed: 12/05/2022] Open
Abstract
Purpose To investigate the diagnostic effectiveness of dacryoscintigraphy in children with tearing; to evaluate tear clearance rate as a diagnostic factor of dacryoscintigraphy in children with tearing; and to analyze the results of treatment according to dacryoscintigraphic findings in children with tearing. Methods Between January 2010 and April 2014, 176 eyes of 88 children with tearing (49 boys and 39 girls; mean age, 23.81 ±14.67 months; range, 12 to 72 months) were studied retrospectively. Of these, 37 of 88 children with tearing were bilateral cases, and 51 were unilateral cases. None of the patients had a history of craniofacial disorder or trauma. The chief complaint of tearing with or without eye discharge and delivery mode, past history of neonatal conjunctivitis, syringing, or probing were collected from parents, grandparents, or previous hospital data. The drainage pattern of the nasolacrimal duct was analyzed, and the clearance rate of 50 µCi 99m technetium pertechnetate was measured by dacryoscintigraphy. Results According to the dacryoscintigraphy results, 98 of 125 eyes (78.4%) with tearing showed nasolacrimal obstruction and 29 of 51 eyes (56.9%) without tearing showed patency. There was a significant difference between tearing eyes and normal eyes (p = 0.001). The clearance rate difference after 3 and 30 minutes was 16.41 ± 15.37% in tearing eyes and 23.57 ±14.15% in normal eyes. There was a significant difference between epiphoric eyes and normal eyes (p = 0.05). Based on the dacryoscintigraphic findings, nasolacrimal-duct obstruction was treated with probing or silicone-tube intubation. The majority of patients showed symptom improvement (75.2%) during the two months of follow-up. Conclusions Dacryoscintigraphy is a non-invasive method of qualitatively and quantitatively diagnosing nasolacrimal duct obstruction in children with tearing.
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Affiliation(s)
- Hyung Chul Kim
- Department of Ophthalmology, Bundang CHA Hospital, CHA University, Seongnam, Korea
| | - A Ran Cho
- Seoul St. Mary's Eye Hospital, Suwon, Korea
| | - Helen Lew
- Department of Ophthalmology, Bundang CHA Hospital, CHA University, Seongnam, Korea
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Dotan G, Nelson LB. Congenital nasolacrimal duct obstruction: common management policies among pediatric ophthalmologists. J Pediatr Ophthalmol Strabismus 2015; 52:14-9. [PMID: 25365513 DOI: 10.3928/01913913-20141028-01] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 10/02/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To study common management policies of congenital nasolacrimal duct obstruction (CNDLO) among pediatric ophthalmologists. METHODS A 21-question survey was sent to members of the American Association for Pediatric Ophthalmology and Strabismus in April 2014. The questions focused on treatment of CNLDO during the first year of life, primary and secondary surgical interventions, surgical techniques, and amblyopia assessment. RESULTS One hundred twenty-seven members completed the survey and 121 responses were analyzed after replies of 6 candidates in training were excluded. Eighty-two percent of respondents instructed caregivers to massage the nasolacrimal duct during the first year of life; however, 55% did not perform the Crigler massage in the office. Outpatient probing was done by 17% of pediatric ophthalmologists who took the survey, almost all of whom (95%) have been in practice more than 10 years. Ninety-one percent recommended surgery for CNLDO close to the age of 1 year and 79% performed probing as initial treatment at that age. If treatment is delayed to the age of 2 years, 53% favored silicone tube intubation and/or balloon dacryoplasty. Following failed probing, silicone tube intubation was performed by 51% of practitioners. Ninety-one percent of respondents routinely checked refraction of infants with CNLDO and recommended reexamination even if initial assessment was entirely normal. CONCLUSIONS This study highlights the striking lack of consensus among pediatric ophthalmologists in many aspects of management of CNLDO and allows practitioners to compare their practice patterns regarding CNLDO management with those of their peers; however, because it provides only the opinions of a limited group of pediatric ophthalmologists, it does not imply that less common practices are wrong.
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