Abstract
We compared the effectiveness of inhaled sevoflurane versus physical restraint during probing in children with congenital nasolacrimal duct obstruction (CNLDO). We performed a retrospective review of children with CNLDO who underwent office probing procedures by a single surgeon under sedation or restraint. Patients’ characteristics at the time of probing, including age, sex, laterality, previous non-surgical treatment, presence of dacryocystitis, outcomes of probing, and complications were compared between the sedation and restraint groups. A multivariable logistic regression analysis was performed to investigate the prognostic factors associated with the success of probing. A subgroup analysis by 12 months of age was also conducted. The overall success rate was 88.6% in 202 eyes of 180 consecutive children (mean age, 15.1 ± 7.7 months). The sedation group had a marginally higher success rates than the restraint group (93.8% vs. 85.1%, p = 0.056). The success rate was not significantly different between the two groups in children aged <12 months (90.9% vs. 93.1%, p = 0.739), but it was significantly higher in the sedation group (94.7% vs. 77.8%. p = 0.006) in children aged ≥12 months. Inhalation sedation was the most potent factor associated with success (adjusted odds ratio = 5.56, 95% confidence interval = 1.33–23.13, p = 0.018) in children aged ≥12 months. There were no surgical or sedation-related complications intra- and postoperatively. Inhaled sevoflurane sedation resulted in more successful, controlled, painless probing, particularly in children aged ≥12 months. It represents a safe, efficient alternative to general anesthesia.
Highlights
Congenital nasolacrimal duct obstruction (CNLDO) commonly occurs in infants, and often spontaneously resolves within the first year of life [1,2]
The sedation group had a marginally higher success rate than the restraint group (93.8% vs. 85.1%, p = 0.056)
Several previous studies have suggested that the success rate of probing for CNLDO could differ depending on surgical setting, the patient’s age, and the surgeon’s skill and experience [3,4,5,11,12]
Summary
Congenital nasolacrimal duct obstruction (CNLDO) commonly occurs in infants, and often spontaneously resolves within the first year of life [1,2]. If CNLDO persists despite conservative management such as lacrimal sac massage and/or topical antibiotics, nasolacrimal duct probing may be performed [1,2]. The setting of probing remains controversial, as office-based probing is usually performed using topical anesthesia under physical restraint. Lee KA et al found that the success rate of probing was 18% lower in an office setting under restraint than in a surgical facility under GA [4]. Miller et al reported a higher success rate under GA compared with probing under restraint (relative risk = 1.27 to 1.36) and attributed this to the fact that officebased physical restraint offers less control and provides less cooperative conditions [5]. There have been concerns that GA in early childhood carries short- and long-term safety issues, requires longer procedure times, and results in higher costs [7,8]
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