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Primary treatment of nasolacrimal duct obstruction with balloon catheter dilation in children younger than 4 years of age.

ABSTRACT: To report the outcome of nasolacrimal duct balloon catheter dilation as the primary treatment of congenital nasolacrimal duct obstruction (NLDO) in children younger than 4 years of age.One hundred two children (151 eyes) ages 12 to <48 months (mean, 23 months) at the time of surgery, who previously had not undergone a nasolacrimal surgical procedure and who presented with at least one of the following clinical signs of NLDO--epiphora, increased tear lake, and/or mucous discharge--were enrolled in a prospective, nonrandomized observational multicenter study (20 sites). All children received balloon catheter dilation of the nasolacrimal system of the affected eye(s).Treatment success was defined as no epiphora, increased tear lake, and/or mucous discharge present at the outcome visit at 1 month after surgery. The proportion of eyes treated successfully was 82% (95% CI: 74%-88%). The dye disappearance test at outcome was normal in 105 (73%), indeterminate in 15 (10%), and abnormal in 23 (16%) of the 143 eyes tested.In children 12 to <48 months of age, balloon catheter dilation as a primary treatment of NLDO was successful in approximately 80% of cases. Because we did not perform a randomized trial with a comparison group, we were unable to determine how this procedure's success rate compares with that of simple probing or nasolacrimal intubation in this age group.

SUBMITTER: Pediatric Eye Disease Investigator Group

PROVIDER: S-EPMC2743152 | biostudies-literature | 2008 Oct

REPOSITORIES: biostudies-literature

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Primary treatment of nasolacrimal duct obstruction with balloon catheter dilation in children younger than 4 years of age.

Repka Michael X MX Melia B Michele BM Beck Roy W RW Chandler Danielle L DL Fishman Deborah R DR Goldblum Todd A TA Holmes Jonathan M JM Perla Bernard D BD Quinn Graham E GE Silbert David I DI Wallace David K DK

Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 20081001 5

<h4>Purpose</h4>To report the outcome of nasolacrimal duct balloon catheter dilation as the primary treatment of congenital nasolacrimal duct obstruction (NLDO) in children younger than 4 years of age.<h4>Methods</h4>One hundred two children (151 eyes) ages 12 to <48 months (mean, 23 months) at the time of surgery, who previously had not undergone a nasolacrimal surgical procedure and who presented with at least one of the following clinical signs of NLDO--epiphora, increased tear lake, and/or m ...[more]

PMID: 18929305

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Project description:ImportanceAlthough the overall rate of spontaneous resolution in congenital nasolacrimal duct obstruction (CNLDO) and efficacy of probing have been documented in the literature, the optimal timing of intervention has not been established.ObjectiveTo report new findings regarding spontaneous resolution in a large cohort of children with CNLDO.Design, setting, and participantsThe medical records of 1998 consecutive infants diagnosed with CNLDO from January 1, 1995, through December 31, 2004, while residing in Olmsted County, Minnesota, were retrospectively reviewed. Data were analyzed between January 1, 2015, and January 2017.Main outcomes and measuresRate of spontaneous resolution over time and by sex.ResultsThe cohort, diagnosed at a median age of 1.2 months (interquartile range, 0.4-3.6), was 48% girls (n = 959) and 89% white (n = 1626; 173 were unreported). Among the 1998 cases, 1669 (83.5%) spontaneously resolved, 289 (14.5%) underwent treatment, and the remaining 40 (2.0%) were lost to follow-up. Of the 1958 infants followed up, CNLDO in 925 (47.3%) spontaneously resolved by age 3 months, in 1300 (66.4%) by 6 months, in 1472 (75.7%) by 9 months, and in 1516 (78.4%) by 12 months. The rate of resolution was 35% faster (95% CI, 23%-47%; P < .001) at less than 1 month vs 3 months, 43% faster (95% CI, 27%-64%; P < .001) at 3 months vs 6 months, 39% faster (95% CI, 16%-64%; P < .001) at 6 months vs 9 months, and 1% slower at 9 months vs 12 months (hazard ratio, 0.99; 95% CI, 0.80-1.22; P = .78). Congenital nasolacrimal duct obstruction resolved in boys 0.5 months (95% CI, 0.2-0.8; P < .001) faster than girls (median, 2.9 vs 3.4 months), and unilateral obstructions resolved 0.2 months (95% CI, 0.1-0.4; P = .002) faster than bilateral (median, 3.1 vs 3.3 months) ones. Children probed at 15 months or older had decreased odds of resolution after probing (odds ratio, 0.11; 95% CI, 0.01-0.89; P = .04) compared with children probed at age 12 to 14 months.Conclusions and relevanceBased on this large cohort of children with CNLDO, probing between age 9 and 15 months may be reasonable given that the rate of spontaneous resolution plateaued after 9 months and initial probing success declined after 15 months. This time frame supports both an earlier and narrower range of ages for intervention compared with the current practice of probing after age 1 year.

Dataset Information

Primary treatment of nasolacrimal duct obstruction with balloon catheter dilation in children younger than 4 years of age.

Publications

Primary treatment of nasolacrimal duct obstruction with balloon catheter dilation in children younger than 4 years of age.

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