Endoscopic Abnormalities in Children with Nasolacrimal Duct Obstruction
Zisansha Zahirsha; Marlo Galli CO; Gregg Lueder MD
St. Louis Children’s Hospital, Washington University School of Medicine
Saint Louis, MO
Introduction: To report the incidence of endoscopic abnormalities in children with nasolacrimal duct (NLD) obstruction and analyze the surgical outcomes of NLD probing and endoscopy in young children.
Methods: Nasal endoscopy was performed in conjunction with NLD probing in 152 eyes of 100 consecutive patients between 6 and 18 months of age. Retrospective review of the medical records was performed to identify the number of patients with endoscopic abnormalities. The types of endoscopic abnormalities and results of endoscopically-guided removal of cysts in conjunction with NLD probing were analyzed.
Results: NLD cysts were identified in 15 (15%) patients. 1 patient had an inferior turbinate apposed to the lateral nasal wall, and 84 patients had no endoscopic abnormalities. The success rate of NLD probing was 95% in patients without abnormalities and 87% in patients with NLD cysts treated with cyst removal and NLD probing.
Discussion: NLD cysts were found in 15% of patients who presented with typical symptoms of NLDO. The success rate of surgery for patients without cysts (95%) was higher than in most published reports, suggesting that unrecognized cysts may contribute to failure in some patients treated with NLD probing alone. NLD probing in conjunction with cyst removal had a high rate of success (87%) in patients with these endoscopic abnormalities.
Conclusion: The findings of this study call for more research into comparing endoscopic-guided probing to standard probing and provide support for the procedure’s use in clinical practice. NLD cysts are fairly common in children with NLDO. Endoscopy may identify these abnormalities and facilitate their removal, which may improve surgical outcomes.
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2. Wallace EJ, Cox A, White P, MacEwen CJ. Endoscopic-assisted probing for congenital nasolacrimal duct obstruction. Eye. 2005;(20):998-1003. doi:10.1038.