Abstract
Background To report the outcomes of balloon catheter dilatation and silicone intubation as a sequential secondary surgery under the same anesthesia, a stepwise approach for congenital nasolacrimal duct obstruction (NLDO) when probing and irrigation as primary procedure fails. Methods A retrospective study included children with NLDO who underwent probing and irrigation only, and those who underwent in the same surgery under anesthesia, adjunct balloon catheter dilation and silicone intubation due to difficulty of the probe passage or fluid regurgitation from the punctum. The primary outcome was surgical success defined as resolution of preoperative symptoms and signs at 1 month. Results A total of 105 NLDO cases were included. Eighty-four cases underwent probing and irrigation only, whereas 21 cases required balloon dilation and silicone intubation consecutively after the first procedure. Patient age at surgery was higher for those requiring balloon dilatation and intubation (30.3 ± 8.0 months) when compared to those with probing and irrigation only (22.4 ± 10.3 months, p < 0.001). The onset of symptoms, preoperative clinical findings regarding tearing and discharge and gender distribution of patients were comparable between the two groups. During the follow-up, the overall success rate for probing and irrigation only was 76.2% (64 out of 84 cases) and for balloon dilatation and silicone tube intubation was 90.5% (19 out of 21 cases). Conclusions The surgical team may prepare to proceed with secondary surgery under the same anesthesia after the initial attempt of probing and irrigation. This stepwise two-stage approach in patients with congenital NLDO failing primary surgery resulted in a high success rate with minimal interventions, avoiding repeated general anesthesia.
Highlights
Congenital nasolacrimal duct obstruction (NLDO) is a common condition of infancy and early childhood, in which there is a failure in the development of the nasolacrimal duct drainage system
The patient will have an overflow of tears, discharge, and mild palpebral inflammation. e prevalence of NLDO ranges from 5% to 20% in the early phase of childhood, but more than 90% of cases will resolve before the age of 1 year [1]
The study groups were biased having the primary surgery more complicated in children with balloon catheter dilatation and silicone tube intubation, the success rates were high in both groups
Summary
Congenital nasolacrimal duct obstruction (NLDO) is a common condition of infancy and early childhood, in which there is a failure in the development of the nasolacrimal duct drainage system. E most common first-line treatment is probing and irrigation of the nasolacrimal system with a 75–90% success rate [5] Another surgery, such as balloon catheter dilatation and/or silicone intubation may be required. To report the outcomes of balloon catheter dilatation and silicone intubation as a sequential secondary surgery under the same anesthesia, a stepwise approach for congenital nasolacrimal duct obstruction (NLDO) when probing and irrigation as primary procedure fails. Patient age at surgery was higher for those requiring balloon dilatation and intubation (30.3 ± 8.0 months) when compared to those with probing and irrigation only (22.4 ± 10.3 months, p < 0.001). Is stepwise two-stage approach in patients with congenital NLDO failing primary surgery resulted in a high success rate with minimal interventions, avoiding repeated general anesthesia Conclusions. e surgical team may prepare to proceed with secondary surgery under the same anesthesia after the initial attempt of probing and irrigation. is stepwise two-stage approach in patients with congenital NLDO failing primary surgery resulted in a high success rate with minimal interventions, avoiding repeated general anesthesia
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