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Abstract
To evaluate the role of probing in congenital nasolacrimal duct obstruction in children
age 2 years and older and to establish factors predictive of the outcome.
The study was a single-center, prospective, interventional case series. Sixty patients
with congenital nasolacrimal duct obstruction aged 24 months or older (range, 24 to
186 months; median, 33 months) presenting consecutively to the authors' institutional
referral practice were studied. Probing of the nasolacrimal system under general anesthesia
was the surgical intervention. Success of probing was the main outcome measure. Success
was predefined as complete resolution of symptoms and signs (tearing, crusting, discharge,
regurgitation on pressure over the lacrimal sac) of congenital nasolacrimal duct obstruction
within 3 weeks of the procedure and continued remission at 6 months. Two attempts
at probing were necessary before the procedure was declared a failure.
One attempt at probing resulted in resolution in 73.3% (44 of 60) patients. Sixteen
patients needed a repeat procedure. The overall success rate was 80% (48 of 60). Two
specific types of obstructions of the nasolacrimal duct were recognized on probing:
membranous and firm. Factors predictive of failure of probing were age older than
36 months (P <.0001); bilateral affection (P =.012); failed conservative therapy (P
=.015); failed earlier probing (P <.0001); dilated lacrimal sac (P <.0001); and firm
obstruction (P <.0001).
Results indicate that probing is a viable primary surgical option for congenital nasolacrimal
duct obstruction in children who present between 2 and 3 years of age, and identify
factors predictive of poor prognosis.