The Outcomes of Lacrimal Massage or Probing Treatments at Early and Late Ages for Congenital Nasolacrimal Duct Obstruction

Abstract

Aim: To determine the success rates of lacrimal massage and probing according to age groups for congenital nasolacrimal duct obstruction (CNDO) and emphasize the outcomes of these treatments at early and late ages. Material and Method: Between April 2000 and March 2009, two hundred and ninety-four eyes of 203 patients diagnosed with congenital nasolacrimal duct obstruction were retrospectively examined. According to symptoms and age, patients were treated with lacrimal massage and antibiotic therapy or probing and irrigation under general anesthesia. The cases were divided into two groups: Group 1 (lacrimal massage and antibiotic treatment) and Group 2 (probing and irrigation treatment). Results: In group 1, the cases were 1-42 months of age (mean 16.6 +/- 10.4 months) and were followed-up 2-32 months (mean 9.5 +/- 8.4 months). Proportions of eyes treated successfully were 53.7% overall, 96% for the 25 eyes in children 0 to 6 months old, 51.3% for the 37 eyes in children 7 to 12 months, 53.3% for the 30 eyes in children 13 to 18 months, and 39.7% for the 68 eyes in children 19 to 36 months. In group 2, the cases were 9-84 months of age (mean 24.5 +/- 13.1 months) and were followed-up 2-38 months (mean 11.1 +/- 10.6 months). Proportions of eyes treated successfully were 86.5% overall, 94.1% for the 17 eyes in children 9 to 12 months old, 93.1% for the 44 eyes in children 13 to 18 months, 93.7% for the 32 eyes in children 19 to 24 months, 84% for the 25 eyes in children 25 to 36 months, 71.4% for the 7 eyes in children 37 to 48 months, and 66.6% for the 9 eyes in children 49 to 84 months. Conclusions: In the 0-1 age group, lacrimal massage and antibiotic treatment are the first therapeutic option. Early probing before 12 months of age should be refrained from unless symptoms such as dacryocystitis or severe blepharitis are presented. We consider that delay in probing is a viable option with mild symptoms up to the age of 18 months, or later if the parents wish it. Probing is successful in the older age group and can be performed up to the age of 5 years, but the success rates decrease with increasing ages of cases. (Turk Arch Ped 2010; 45: 359-65)