Abstract
Purpose :
The success rate of lacrimal probing for congenital nasolacrimal duct obstruction (CNLDO) has been found to be lower in children with concurrent craniofacial abnormalities. Persistent symptoms are addressed with dacryocystorhinostomy (DCR). There is little data on the effectiveness of DCR for patients in this group. This retrospective observational study compared the clinical characteristics and outcomes of DCR for CNLDO in children with and without concurrent craniofacial abnormalities.
Methods :
Chart review was completed of a single institution cohort including all patients <16 years of age who underwent DCR for CNLDO over a 20-year period. Patients with acquired NLDO and those who did not attend at least one postoperative visit were excluded. Patients with isolated or syndromic craniofacial abnormalities were included in the craniofacial cohort.
Results :
DCR for treatment of CNLDO was required for 40 eyes among 29 patients. Craniofacial abnormalities were present in 21 of the 40 eyes. Mean age at the time of surgery was 5.8 years and 52.5% were female. There was no significant difference in age at time of surgery or patient sex between the craniofacial and simple CNLDO groups. Craniofacial patients were significantly more likely to have concurrent canalicular pathology (p=0.03) and require intraoperative multidisciplinary collaboration with otorhinolaryngology and ophthalmology (p=0.0006). There was no significant difference in use of intraoperative navigation, surgical approach (endoscopic versus external), or additional procedures conducted under anesthesia. Four of 21 DCRs in the craniofacial group were revisions compared to one revision in the simple CNLDO group. Three of 19 patients in the simple CNLDO group had remaining symptoms after surgery compared to 7 of 21 patients in the craniofacial cohort (p=0.28).
Conclusions :
CNLDO in patients with associated craniofacial abnormalities is more likely to present with coexisting canalicular pathology and require multidisciplinary care compared to patients with simple CNLDO. Failure rate may be higher with craniofacial abnormalities, but larger case numbers are needed to confirm this trend. Further studies could examine whether specific DCR approaches (endoscopic versus external) produce better functional and anatomical outcomes in CNLDO associated with craniofacial abnormalities.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.