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E. M. Gianfermi, J. D. Baker, J. D. Roarty; The Effectiveness of Surgical Intervention in the Treatment of Congenital Nasolacrimal Duct Obstruction. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4831.
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To investigate the necessity and success of surgical intervention in the treatment of congenital nasolacrimal duct obstruction (NLDO) at a tertiary care center.
A retrospective chart review was performed on patients with the diagnosis of congenital NLDO who were managed both conservatively and surgically. Conservative management included observation, Crigler massage, warm compresses, and topical antibiotics. Surgical management included probe and irrigation (P&I), balloon dacryoplasty, silicone intubation, inferior turbinate infracture, and dacryocystorhinostomy. The patient demographics, age at onset of symptoms, number of patients treated conservatively versus surgically, the success rate of conservative management and of each surgical intervention, and the complications encountered were all reviewed.
409 eyes of 298 patients were diagnosed with congenital NLDO over a 2 year period, 85% had symptoms at birth and 98% by 12 months of age, and 37.2% had bilateral obstruction. Conservative management was attempted in 58% of patients with a 53% success rate. The 152 primary surgical interventions included 120 P&Is, 27 balloon dacryoplasties, and 5 silicone intubations. The success rate for primary P&I was 64% and balloon dacryoplasty was 78%. Silicone intubation had the highest overall success rate of 80%. The P&I results are outlined in table 1, the failure rate was 36%, with a higher failure rate in bilateral disease. An age difference of 4 months between successful and failed P&Is was not statistically significant (p<0.15). No complications were documented in any of the surgical procedures.
P&I is a successful and safe surgical intervention in the treatment of NLDO, primarily and after failed conservative management. The success of P&I as a primary surgical intervention in our study was 64%, slightly lower then the 75-85% previously reported. Failure rate of P&I does not increase with delayed timing of the probing procedure. A higher failure rate for P&I in patients with bilateral disease may suggest more significant anatomical abnormalities in the nasolacrimal duct system.Table 1
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