Pediatric dacryocystorhinostomy for nasolacrimal duct obstruction

Abstract

Objective To determine the outcome of pediatric dacryocystorhinostomy (DCR) for large mucoceles or for primary nasolacrimal duct obstruction unresponsive to multiple probings. Design Retrospective noncomparative case series. Participants One hundred thirty-four external dacryocystorhinostomies were performed in 121 children. Methods Clinical case notes were reviewed for a series of cases operated on at Moorfields Eye Hospital by specialist lacrimal surgeons between 1987 and 1999. Main outcome measures Postoperative relief of presenting symptoms and signs and complications. Results Fifty-nine percent of admissions (75 of 127) were day cases, and the other 52 admissions were inpatient. Simultaneous bilateral surgery was performed in 7 of 121 (6%) children, all but one having day case admission, and sequential bilateral surgery in 6 of 121 (5%) cases. Silicone intubation was performed in 20% of operations, these generally being early in the series. Three children had Down syndrome, five had craniofacial anomalies, and two had systemic disorders. Mild postoperative cellulitis occurred in three cases, all of which settled without complication after systemic antibiotic therapy, and there was one case of suture granuloma. There were no cases of immediate postoperative complication in either the day case or the inpatient groups. Complete cure of symptoms was achieved in 96% and an improvement of symptoms (with mild persistence of epiphora under challenge) in five cases (4%). Conclusion For surgeons experienced in pediatric lacrimal surgery, external DCR with sutured mucosal flaps can be accomplished through an 8-mm incision with no surface sutures and minimal scarring. Symptoms are improved in all cases and complete cure achieved in 96%, with no immediate postoperative complications and only few (3%) short-term complications. The surgery is amenable to day case management, without significant morbidity, and may be performed as a simultaneous bilateral procedure.