The natural process of congenital nasolacrimal duct obstruction and effect of lacrimal sac massage.

Abstract

This study aimed to examine the rate of symptomatic improvement of congenital nasolacrimal duct obstruction (CNLDO) in infants treated with conservative management within the first year of age. Other purpose of the study is to emphasize the relationship between spontaneous resolution time and effective lacrimal sac massage. Thirty-one infants were diagnosed to have CNLDO by an ophthalmologist prior to 3 months of age. In this study, 36 eyes of 31 patients were included with CNLDO. The patients were divided into two groups. Group 1 (28 eyes of 24 patients) was consisted of the patients who were applied effective lacrimal sac massage regularly during the follow-up period, and patients whose parents did not apply a regular lacrimal passage regularly were accepted as group 2 (8 eyes of 7 patients). Thirty-three eyes of 31 patients (18 rights and 15 left) successfully resolved with only conservative management (91.6%). In these thirty-three eyes, one eye (3%) resolved between 0 and 3months, fourteen eyes (42.5%) resolved between 4 and 6months, eleven eyes (33.3%) resolved between 7 and 9months, and seven eyes (21.2%) resolved between 10 and 12months. CNLDO was resolved in 27 (96.2%) of 28 eyes in group 1, and in group 2, six eyes (77.7%) had resolvement. This difference was statistically significant (p=0.001). The mean age of resolution was 6.8±1.88months in group 1, 10.3±1.5months in group 2 (p < 0.001). In light of our study, we believe that conservative management of CNLDO is highly successful. Our study provided a possible objective explanation for the efficacy of lacrimal sac massage. Emphasizing the importance of the massage to parents and describing in detail can reduce the risk of unnecessary surgical interventions.