Clinical Outcome of Probing in Infants with Acute Dacryocystitis - A Prospective Study.

Abstract

Acute dacryocystitis is an uncommon but serious condition in infants and needs immediate treatment. Although, medical management with systemic antibiotics remains the mainstay of initial treatment, there are recent studies justifying simultaneous Naso Lacrimal Duct (NLD) probing with acceptable success rate. To assess the success rate of probing in the management of infantile acute dacryocystitis and to analyse the factors affecting it. A prospective interventional study was designed and infants presenting with acute dacryocystitis with or without complications like dacryocystopyocele/ lacrimal abscess/preseptal cellulitis at a Tertiary Eye Care Centre from May 2014 to April 2016 were enrolled. Demographic details and baseline clinical characteristics were noted. Intravenous antibiotics were started and probing under general anaesthesia was done. Follow up was done after one month. Success was defined as subsidence of acute attack and resolution of epiphora at final follow up of one month. A total 20 eyes of 18 patients were included with male: female ratio 10:8. Mean age of patients was 6.5 months and the mean duration of symptoms was 5.6 days. Dacryocystitis with lacrimal swelling was present in five eyes, preseptal cellulitis was present in two eyes while the rest 13 eyes presented with simple inflammation over the lacrimal sac. After one month, 85% (17eyes) had complete resolution of symptoms. Recurrence of epiphora was seen in 15% (three eyes) after initial improvement. Medical management with simultaneous probing of nasolacrimal duct has fairly good success rate in infantile dacryocystitis. Presence of dacryopyocele or dacryocystocele can lead to failure of probing owing to presence of intranasal cysts.