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

Abstract

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.

Figure 1

Treatment Success by Age at Probing Treatment success is defined as no epiphora, mucous discharge, or increased tear lake present at the outcome exam. Both point estimates and 95% confidence intervals are adjusted to account for intereye correlation in bilateral cases.