J Korean Ophthalmol Soc.  2009 Jun;50(6):816-820. 10.3341/jkos.2009.50.6.816.

Clinical Characteristics and Treatment of Congenital Nasolacrimal Duct Obstruction

• Suh SC
• Ha MS

• KMID: 2212356
• DOI: http://doi.org/10.3341/jkos.2009.50.6.816

Abstract

PURPOSE: A comparison analysis of the clinical characteristics and treatment results of congenital NLD obstruction.
METHODS
The present study involved 216 pediatric patients (258 eyes) diagnosed with and treated for congenital NLD obstruction. Treatment was applied step by step starting with conservative massaging, lacrimal probing, and silicone tube intubation.
RESULTS
The treatment results of congenital NLD obstruction in pediatric patients under 12 months of age showed an 87.3% success rate after an average of 4.3 months of treatment in the group using lacrimal sac massage and antibiotic eye drops (conservative treatment). The group treated by correct massaging techniques showed a 93.6% success rate after an average of 3.8 months of treatment. The success rate of lacrimal probing, applied to patients not showing improvement after massage therapy was 77.8%. Pediatric patients not showing improvement after lacrimal probing underwent silicone tube intubation. All patients showed improvement except in 1 case that had an early silicone tube dislocation. DISCUSSION: A step-by-step approach is effective in treating congenital NLD obstruction patients, and correct lacrimal massage techniques improve the success rate during conservative therapy. The period of conservative treatment and number of probing times did not have a statistically significant correlation with the success rate of lacrimal silicone tube intubation. Silicone tube intubation showed a high success rate in patients sustaining the silicone tube for a minimum of 2.1 months.

Keyword

Congenital nasolacrimal duct obstruction; Nasolacrimal sac massage; Silicone tube intubation

MeSH Terms

Dislocations
Humans
Intubation
Massage
Nasolacrimal Duct
Ophthalmic Solutions
Silicones
Ophthalmic Solutions
Silicones

Reference

References

1. Albert DM. Principles and practice of ophthalmology. 1st ed.Philadelphia: WB Saunders;1994. p. 2812–26.

2. Guerry D, Kendig EL. Congenital impotency of the nasolacrimal duct. Arch Ophthalmol. 1948; 39:193–204.

3. Guerry D, Kendig EL. Congenital impotency of the nasolacrimal duct. Arch Ophthalmol. 1952; 47:141–58.

4. Noda S, Hayasaka S, Setogawa T. Congenital nasolacrimal duct obstruction in Japanese infants: its incidence and treatment with massage. J Pediar Ophthalmol Strabismus. 1991; 28:20–2.

5. Lee WH, Kim JM, Shin TY. A Statistical investigation of atresia of the nasolacrimal ducts of children. J Korean Ophthalmol Soc. 1972; 13:163–5.

6. Lee SY, Chung HS, Kim HB, et al. The incidence of congenital nasolacrimal duct Obstruction in Korean neonates. J Korean Ophthalmol Soc. 1989; 30:5–8.

7. Oh HS, Ahn Y. The incidence and medical treatment of congenital nasolacrimal duct obstruction in Korean infants. J Korean Ophthalmol Soc. 1995; 36:1000–7.

8. Sevel D. Development and congenital abnormalities of the nasolacrimal apparatus. J Pediatr Ophthalmol Strabismus. 1981; 18:13–9.

9. Katowitz JA, Welsh MG. Timing of irrigation and initial probing in congenital nasolacrimal duct obstruction. Ophtalmology. 1987; 94:698–705.

10. Cassady JV. Developmental anatomy of the nasolacrimal duct. Arch Ophthalmol. 1952; 47:141–58.

11. Cassady JV. Dacryocystitis in infancy. Am J Ophthalmol. 1948; 31:773–80.

12. Paul TO, Shepherd R. Congenital nasolacrimal duct obstruction: natural history and the timing of optimal intervention. J Pediatr Ophthalmol Strabismus. 1994; 31:362–7.

13. Peterson Ra, Robb RM. The natural course of congenital obstruction of the nasolacrimal duct. J Pediatr Ophthalmol Strabismus. 1978; 15:246–50.

14. Crigler LW. The treatment of congenital dacryocystitis. JAMA. 1923; 81:23–24.

15. Price H. Dacryostenosis. J Pediatr. 1947; 30:300–5.

16. Young JDH, MacEwan CJ, Ogstone SA. Congenital nasolacrimal duct obstruction in the second year of life: a multicentric trial of management. Eye. 1996; 10:485–91.

17. Havins HE, Wilkins RB. A useful alternative to silicone intubation in congenital nasolacrimal duct obstructions. Ophthalmic Surg. 1983; 14:660–70.

18. Sturrock SM, MacEwan CJ, Young JD. Long term results after probing for congenital nasolacrimal duct obstruction. Br J Ophthalmol. 1994; 78:892–4.

19. Moon JS, Choi WC. Office Probing of Congenital Nasolacrimal Duct Obstruction. J Korean Ophthalmol Soc. 1999; 40:2357–61.

20. Ahn DH, Lew H, Kim HY, Lee SY. The Effect of Probing for Congenital Nasolacrimal Duct Obstruction. J Korean Ophthalmol Soc. 1998; 39:836–40.