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Office probing for treatment of nasolacrimal duct obstruction in infants.

ABSTRACT: To determine whether demographic or clinical factors are associated with the outcome of office-based nasolacrimal duct probing for the treatment of congenital nasolacrimal duct obstruction (NLDO).In two multicenter prospective studies, 384 eyes of 304 children aged 6 to <15 months with NLDO underwent a nasolacrimal duct probing performed in the office using topical anesthesia. Treatment success, defined as no clinical signs of NLDO (epiphora, increased tear lake, or mucous discharge) and no reoperation, was assessed 1 month after probing in one study and 6 months after probing in the other study. Data from both studies were pooled to evaluate associations between baseline characteristics and treatment success.Office probing was successful in 75% of eyes overall (95% CI, 70%-80%). The procedure was less successful in eyes of children with bilateral NLDO compared with unilateral NLDO (63% vs 80%; relative risk = 0.78 [95% CI, 0.66-0.92]) and in eyes that had 2 or 3 clinical signs of NLDO compared with one (71% vs 83%; relative risk = 0.88 [95% CI, 0.81-0.96]). Treatment success did not appear to be related to age, specific clinical signs of NLDO, prior treatment, or research study.Performing nasolacrimal duct probing in the office successfully treats NLDO in the majority of cases in children aged 6 to <15 months. The success rate is lower with bilateral disease or when more than one clinical sign of NLDO is present.

SUBMITTER: Miller AM

PROVIDER: S-EPMC3936253 | biostudies-literature | 2014 Feb

REPOSITORIES: biostudies-literature

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Office probing for treatment of nasolacrimal duct obstruction in infants.

Miller Aaron M AM Chandler Danielle L DL Repka Michael X MX Hoover Darren L DL Lee Katherine A KA Melia Michele M Rychwalski Paul J PJ Silbert David I DI Beck Roy W RW Crouch Eric R ER Donahue Sean S Holmes Jonathan M JM Quinn Graham E GE Sala Nick A NA Schloff Susan S Wallace David K DK Foster Nicole C NC Frick Kevin D KD Golden Richard P RP Lambert Scott R SR Tien D Robbins DR Weakley David R DR

Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 20140201 1

<h4>Purpose</h4>To determine whether demographic or clinical factors are associated with the outcome of office-based nasolacrimal duct probing for the treatment of congenital nasolacrimal duct obstruction (NLDO).<h4>Methods</h4>In two multicenter prospective studies, 384 eyes of 304 children aged 6 to <15 months with NLDO underwent a nasolacrimal duct probing performed in the office using topical anesthesia. Treatment success, defined as no clinical signs of NLDO (epiphora, increased tear lake, ...[more]

PMID: 24568978

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Project description:Importance:Although 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. Objective:To report new findings regarding spontaneous resolution in a large cohort of children with CNLDO. Design, Setting, and Participants:The 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 Measures:Rate of spontaneous resolution over time and by sex. Results:The 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 Relevance:Based 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

Office probing for treatment of nasolacrimal duct obstruction in infants.

Publications

Office probing for treatment of nasolacrimal duct obstruction in infants.

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