The role of nasal endoscopy in repeat pediatric nasolacrimal duct probings

Abstract

Purpose: To determine whether pediatric nasal endoscopy improves treatment success in recurrent nasolacrimal duct obstruction. Methods: A retrospective analysis was carried out on 2 nonrandomized cohorts of consecutively treated patients who had one failed nasolacrimal duct probing at the Hospital for Sick Children, University of Toronto. The first cohort of 24 consecutive patients (32 eyes), group A, was treated with Crawford silicone tube intubation by one ophthalmologist (R.C.P.). The second cohort of 23 consecutive patients (33 eyes), group B, was treated with repeat probing by a second ophthalmologist (A.V.L.) in conjunction with nasal endoscopy by one otolaryngologist (V.F.). Abnormalities found on endoscopy were treated accordingly, and no tubes were inserted. Follow-up, through phone interviews or office visits, was conducted to assess the patients' symptoms. Results: Group A patients were older at both the first probing (P =.048) and the second procedure (P =.012). No significant difference in the failure rates was found, with treatment failing in 3 eyes (2 patients) in group A and in 5 eyes (4 patients) in group B (P =.479). Interestingly, 17 of the 32 tubes in group A were extruded in 1 month or less. Also, 28 of 33 eyes in group B had abnormalities on endoscopy—some, multiple. Twenty-two eyes underwent inferior turbinate infracture: 5 had redundant mucosa, which was removed, and 6 had abnormal openings of the inferior meatus. Conclusions: We were unable to show any benefit of nasal endoscopy over intubation of the nasolacrimal system with silicone tubes in the treatment of failed probings despite the identification and treatment of abnormalities. The study was limited by its low power to detect differences because of the small number of patients and the high success rate of the traditional treatments for congenital nasolacrimal duct obstruction. (J AAPOS 2001;5:148-52)