Resolution Rates in Congenital Nasolacrimal Duct Obstruction Managed with Massage and Antibiotics Compared to Observation Alone
Saraniya Sathiamoorthi, BS; Ryan D. Frank, MS; Brian G. Mohney, MD
Introduction: Although digital nasolacrimal massage and topical antibiotics are commonly recommended for management of congenital nasolacrimal duct obstruction (CNLDO), their influence on resolution is unknown. The purpose of this study was to determine if the use of nasolacrimal massage or topical antibiotics is associated with higher rates of spontaneous resolution compared to observation alone.
Methods: The medical records of all children < 5 years diagnosed with CNLDO over a 10-year period were retrospectively reviewed. Patients were, at the discretion of their care provider, prescribed the administration of digital massage, topical antibiotics, both, or neither (observation).
Results: Of 1998 infants diagnosed with CNLDO at a mean age of 5 weeks, 527 (26.4 %) were merely observed, 516 (25.8 %) were prescribed massage, 495 (24. 8%) were prescribed at least one course of topical antibiotics, 405 (20.2 %) were prescribed both topical antibiotics and massage, and 55 (2.8 %) did not have documented therapy. The resolution rate, during a median follow-up of 3.1 months, was 73.1% for the merely observed, 88.0% for those with digital massage, 85.3 % for those prescribed antibiotics, and 88.9% for those treated with both (p<0.01).
Discussion: Although there are rare reports of small series suggesting the efficacy of digital massage in resolving CNLDO compared to observation alone, reports on the effectiveness of topical antibiotics are nonexistent.
Conclusion: Prescribing topical antibiotics and digital massage for infants with CNLDO, individually or in combination, is associated with a higher rate of resolution than observation alone.