American Orthoptic Journal Abstract
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Volume 49, 1999, p. 163–168
Treatment of Congenital Nasolacrimal Duct Obstruction (Abstract)
Tom Ghuman, M.D.,
Carlos Gonzales, M.D.,
Malcolm L. Mazow, M.D.
Objective:
To compare the success rate of different modalities used to treat congenital nasolacrimal duct obstruction (CNLDO) in three different age groups. The three treatments analyzed were massage and antibiotics, probing and irrigation, and Crawford tube placement.
Patients and Methods:
A retrospective chart review was performed of patients who were diagnosed with CNLDO from 1988-1998. A total of 485 eyes from 368 patients were treated for CNLDO. Patients were assigned in three groups based on their age(<13 months, 13-24 months, and >24 months). Every patient received conservative medical management consisting of nasolacrimal sac massage and topical antibiotics. If this failed they then received probing and irrigation of the nasolacrimal duct. Crawford tube placement was the final treatment that was used if the initial two methods failed.
Results:
Massage and irrigation was successful in 32% of the eyes in which the treatment was initiated before the age of 13 months. The success rate decreased after that age to 18% and 22% in age groups 13-24 months and >24 months respectively. Initial probing and irrigation success rates were 76% in-group <13 months, 67% in-group 13-24 months, and 77% in-group >24 months. A second probing and irrigation was only done in children <13 months with resolution of symptoms in 69% of the eyes. Crawford tubes had a high success rate of 100% in ages <13 months, 93% in age 13-24 months, and 96% in age >24 months.
Conclusion:
CNLDO treatment should be tailored to each individual patient. However, certain guidelines can be drawn from this data. All children regardless of their age should receive massage and antibiotic initially before surgical intervention. All patients, if age and weight. permit, should receive probing and irrigation in the office thereby avoiding general anesthesia. If probing and irrigation is done in the operating room under general anesthesia and a bony obstruction is felt during probing, then Crawford tubes should be placed at that time to ensure long term success. Crawford tubes should be reserved as the last treatment modality.
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