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Spontaneous Resolution and Timing of Intervention in Congenital Nasolacrimal Duct Obstruction.

ABSTRACT: 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?

SUBMITTER: Sathiamoorthi S

PROVIDER: S-EPMC6905620 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Spontaneous Resolution and Timing of Intervention in Congenital Nasolacrimal Duct Obstruction.

Sathiamoorthi Saraniya S Frank Ryan D RD Mohney Brian G BG

JAMA ophthalmology 20181101 11

<h4>Importance</h4>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.<h4>Objective</h4>To report new findings regarding spontaneous resolution in a large cohort of children with CNLDO.<h4>Design, setting, and participants</h4>The medical records of 1998 consecutive infants diagnosed with CNLDO from January 1, 1995, throu ...[more]

PMID: 30178001

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Project description:BackgroundCongenital nasolacrimal duct obstruction (CNLDO) is one of the main causes of epiphora in infants, and antibiotics are usually used as a conservative therapy in the first year. Yet, little is known about the bacteriology of the occluded lacrimal drainage system in this group of patients. The aim of this study was to evaluate the microbiology of lacrimal sac (LS) in Chinese children with CNLDO in their first year of life.MethodsPatients with CNLDO between May 1, 2017 and August 31, 2018 at a tertiary care children's hospital were enrolled. The study recruited infants who received lacrimal probing under 1 year old, and refluxed discharge from LS was collected. Samples were cultured and susceptibility test was performed for positive culture.ResultsThirty-two patients with CNLDO were included. The ratio of male to female was 23:9. The mean age was 6.7 ± 2.4 (1.7-12) months. Positive cultures was identified in 87.5% of the sample, and presented 38 strains of bacteria. Mixed infection was identified in 10 (31.3%) children. Gram-positive bacteria accounted for 60.5% of all the strains, with Streptococcus (50%) being the most frequent species, whereas Haemophilus (21.1%) and Neisseriae (13.2%) were most common isolates for Gram-negative organisms. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 2 infants whose symptoms resolved by a routine probing. No difference of bacteriology pattern was detected between patients under 6 months old and those beyond. The pathogens were highly sensitive to chloramphenicol (88%) and levofloxacin (84%), but resistant to erythromycin (40%) and sulfamethoxazole (32%).ConclusionsInfants with CNLDO under 1 year of age presented predominance of Streptococcus as Gram-positive organism, and Haemophilus as Gram-negative organism. Levofloxacin was an active topical antibiotic agent with few chance of resistance especially for Chinese children. These findings could help clinicians choose optimal medicine for CNLDO as the conservative treatments.

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Spontaneous Resolution and Timing of Intervention in Congenital Nasolacrimal Duct Obstruction.

Publications

Spontaneous Resolution and Timing of Intervention in Congenital Nasolacrimal Duct Obstruction.

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