Age Impacts Success of Probing for Congenital Nasolacrimal Duct Obstruction

Although probing for congenital nasolacrimal duct obstruction (CNLDO) is a safe and effective procedure, age at the time of initial intervention and bilateral surgery constitute significant risk factors for a failed procedure, according to study results published in BMC Ophthalmology.

CNLDO is a significant ophthalmological problem that affects around 11% of newborns and is the most common cause of neonatal epiphora (excessive tearing). This condition tends to be more prevalent among White children born prematurely, with risk factors that include maternal infections, exposure to radiation, medications, or occupational hazards experienced during pregnancy.

In children with Down syndrome, the prevalence of CNLDO is between 5% and 30%, whereas “persisting CNLDO, which occurs in 2% to 6% of all cases carries the risk of chronic dacryocystitis, preseptal, and orbital cellulitis,” the researchers wrote.

Spontaneous opening of the nasolacrimal duct occurs in 51.9% to 83.5% of children, and because of this, a conservative treatment is preferred within the first months following birth.

However, “in the event that the use of hydrostatic massage does not lead to the opening of the lacrimal ducts, nasolacrimal duct irrigating and probing is performed under general (GA) or topical anesthesia (TA),” the authors explained.

To evaluate whether a child’s age affects the efficacy of this procedure, researchers carried out an 8-year retrospective analysis. Between May 2012 and April 2020, 2434 children were treated for CNLDO at the Pediatric Ophthalmology Department of a medical university in Poland.

A total of 3009 eyes were included in the study from children aged 2 weeks to 41 months, with a mean (SD) age of 8 (5.6) months. Unilateral occlusion was found in 1859 (76.4%) children, and bilateral nasolacrimal duct obstruction was present in 575 (23.6%).

Participants were divided into 9 age groups. The researchers found bilateral obstruction was associated with a higher percentage of unsuccessful procedures compared with patients with unilateral obstruction (16.9% vs 10.2%; P <. 001 Chi-square test). In addition, the success rate of the initial probing was 87.2% for all children and decreased with age.

Analyses revealed the following success rates:

• Children 0 to 2 months: 87.9%
• Children 3 to 6 months: 91.4%
• Children 7 to 9 months: 89.6%
• Children 10 to 12 months: 86%
• Children 13 to 15 months: 76.3%
• Children 16 to 18 months: 71.3%
• Children 19 to 21 months: 70.3%
• Children 22 to 24 months: 70.2%
• Children over 24 months: 65.4%

Overall, the percentage of failure of the first probing was the lowest among patients aged 3 to 6 months (8.6%) and 7 to 9 months (10.4%).

The researchers noted bilateral obstruction may indicate a more complicated cause of the condition or create greater technical difficulties during procedures, which may impact the rate of less-satisfactory results.

In addition, “older children with CNLDO may represent the pool of patients born with complex, nonvalvular types of obstructions that did not resolve spontaneously in the first months of life and require different procedures, including nasolacrimal duct intubation, laser procedures, and even dacryocystorhinostomy,” the authors wrote.

Because the study consisted of a homogenous population of White children, the findings may not be generalizable to the wider public, marking a limitation of the study. The researchers were unable to collect data on obstruction type during probing, making it impossible to differentiate simple and complex CNLDO.

“Probing between 7 and 9 months appears to be a reasonable treatment strategy for children without recurrent infections. Early surgical intervention may be considered for patients with additional signs,” the authors concluded.

Reference:

Świerczyńska M, Tobiczyk E, Rodak P, Barchanowska D, Filipek E. Success rates of probing for congenital nasolacrimal duct obstruction at various ages. BMC Ophthalmol. Published online October 8, 2020. doi:10.1186/s12886-020-01658-9