Congenital Nasolacrimal Duct Obstruction Research Articles

Correction: Retrospective analysis of bicanalicular lacrimal silicone tube intubation in patients with congenital nasolacrimal duct obstruction: a long-term follow-up study.

Correction: Retrospective analysis of bicanalicular lacrimal silicone tube intubation in patients with congenital nasolacrimal duct obstruction: a long-term follow-up study.

Comparative Analysis of Silicone Tube Intubation Versus Probing and Balloon Dilation for Congenital Nasolacrimal Duct Obstruction: A Systematic Review and Meta-Analysis.

Congenital nasolacrimal duct obstruction (CNLDO) is a pediatric disorder with a wide range of pathology. If untreated, the condition may end up with serious complications. Multiple treatment options for CNLDO exist throughout the literature, and there is an ongoing debate on the best intervention for each disease subgroup and the best timing of such interventions. This study compares the success and failure rates of silicone tube intubation (STI) against probing and balloon dilation (BD). The authors searched the literature for relevant articles using PubMed, Scopus, web of Science, and Cochrane Library until January 2024. Using RevMan 5.4, the authors compared STI's success and failure rates to probing and BD using risk ratios (RRs) and a random-effect model. In addition, the complication rate of monocanalicular intubation (MCI) versus bicanalicular intubation (BCI) was investigated. The authors used the leave-one-out method to check for influential studies and to resolve heterogeneity. The screening process resulted in 23 eligible articles for inclusion in the authors' review. Silicone tube intubation had a higher chance of resolving the symptoms of CNLDO than probing (RR = 1.11; 95% CI: 1.04, 1.20; P = 0.004) while having less risk of surgical failure (RR = 0.48; 95% CI: 0.30, 0.76; P = 0.002]. Monocanalicular intubation showed no statistically significant difference when compared with BCI in terms of surgical success and failure; however, MCI had a lower risk of complications (RR = 0.68; 95% CI: 0.48, 0.97; P = 0.04). In addition, STI did not demonstrate any significant difference from BD. There was no significant difference in success/failure between MCI and BCI; monocanalicular had fewer complications. Silicone tube intubation did better in terms of surgical success than probing, especially in children over 12 months, suggesting that it is the preferred intervention for older patients with CNLDO.

Unlocking the secrets of success in probing for congenital nasolacrimal duct obstruction: investigating the factors that matter.

The objective of this study was to analyze the impact of different factors on the success rate of probing for congenital nasolacrimal duct obstruction (CNLDO). A retrospective analysis was conducted on 239 eyes of 202 patients who underwent probing for CNLDO between 2014 and 2019. Patients were divided into three age groups (12-24months, 25-36months, and over 36months) and two groups based on the type of membranous obstruction (MO) and incomplete complex obstruction (ICO), with complete complex obstruction (CCO) cases being excluded. The study involved administering general anesthesia (GA) to all participants during the probing procedure. The patients were then monitored at scheduled intervals for up to 6 months after the surgery. Success was defined as an improvement in symptoms and signs, and logistic regression and Fisher's exact test were used for statistical analysis. The mean age of the patients was 25.48 ± 13.38months, and the total success rate was 86.61%. The success rate for MO was 92.8%, 95.87%, and 97% in age groups 1, 2, and 3, respectively. The success rate for ICO was 91.17%, 80%, and 23.52% in age groups 1, 2, and 3, respectively. The success rate for MO was significantly higher than ICO in all age groups. The success rate for ICO was significantly lower in age group 3 (p = 0.009). The study found that probing performed within the first 36months had high success rates regardless of age and type of obstruction. However, the success rate significantly decreased in patients undergoing probing for ICO at 36months or later.

The incidence of pediatric dacryocystitis among a population-based cohort of infants with congenital nasolacrimal duct obstruction

PurposeTo report the incidence, clinical characteristics, and outcomes of acute dacryocystitis among a large, population-based cohort of children born with congenital nasolacrimal duct obstruction (CNLDO) over a 10-year period. MethodsThis multicenter retrospective, population-based cohort study included all patients diagnosed with acute dacryocystitis in a cohort of patients diagnosed with CNLDO before age 5 years in Olmsted County, Minnesota, United States of America from January 1, 1995, through December 31, 2004. ResultsOf 1,998 patients with CNLDO, there were 70 cases (36 female [(51%)]) of acute dacryocystitis during the study, yielding an incidence rate of 243 per 100,000 children (95% CI, 170-316). Mean age at diagnosis was 9.0 months. Patients who developed dacryocystitis were significantly less likely to be born via C-section (OR = 0.29, P = 0.009). Less than half of patients with dacryocystitis were treated with oral/intravenous antibiotics (46%), but whose who were had a significantly higher odds of requiring probing (OR = 8.50, P = 0.004). Spontaneous CNLDO resolution was significantly less likely to occur in patients diagnosed with acute dacryocystitis compared with those without (OR = 2.46, P = 0.001). The median age of spontaneous resolution in the dacryocystitis group (6.0 months) was significantly older than the uncomplicated CNLDO group (P = 0.012). ConclusionsPediatric acute dacryocystitis is an uncommon complication of CNLDO and is associated with both a lower likelihood of and older age at spontaneous resolution of CNLDO symptoms.

Retrospective Analysis of Bicanalicular Lacrimal Silicone Tube Intubation in Patients with Congenital Nasolacrimal Duct Obstruction: A Long-term Follow-up Study.

Congenital nasolacrimal duct obstruction (CNLDO) is the most common cause of epiphora in the first year of life. In addition to conservative therapy, there are several invasive methods available. The aim of this retrospective study was to conduct a long-term follow-up of bicanalicular lacrimal duct intubation as the primary intervention in a large cohort of patients with CNLDO. The electronic medical records of 487 patients with CNLDO who underwent bicanalicular tube intubation were reviewed. To determine the long-term outcomes, a telephone interview was conducted. A total of 328 eyes of 235 patients were included in the study. The median average follow-up period was 6.67 (5.58 - 8.67) years. At the time of the survey, 218 patients (92.8%) were symptom free. Mean patient satisfaction with surgical outcome was 10/10. To our knowledge, this study provides the longest follow-up of the largest patient cohort in the literature consisting of patients who underwent probing with bicanalicular lacrimal silicone tube intubation as a primary intervention for CNLDO. This study showed a high long-term postoperative success rate, with high postoperative satisfaction, few complications, and a low need for reintervention.

Nasolacrimal duct Probing versus Silicone Intubation in the Treatment of Complex Congenital Nasolacrimal Duct Obstruction

Nasolacrimal duct Probing versus Silicone Intubation in the Treatment of Complex Congenital Nasolacrimal Duct Obstruction

Virtual Reality and Mixed Reality-Assisted Endoscopic DCR in Extremely Complex Lacrimal Obstructions.

To report the techniques and outcomes of virtual reality (VR) and mixed reality (MR)-assisted powered endoscopic dacryocystorhinostomy (DCR) in extremely complex lacrimal drainage obstructions. A prospective, non-randomized clinical study was performed in complex syndromic congenital nasolacrimal duct obstruction (CNLDO) and post-traumatic secondary acquired lacrimal duct obstruction (SALDO) in the setting of Le Fort fractures. All patients underwent preoperative planning in VR and intraoperative planning with a step ahead with MR assistance during the surgery. Surgery was supported by mixed reality intraoperative guidance with the use of the prearranged 3D models and real-time-rendered digital models. Parameters assessed include demographics, clinical presentation, complexities of the nasolacrimal duct obstruction, preoperative and intraoperative utility of VR and MR models, surgical techniques, complications, and outcomes. The technique is described as a proof of concept in challenging situations with Apert syndrome and traumatic SALDOs with gross malposition of the sac, and gross nasal and lacrimal anatomical deformities. The VR models helped the surgeon to assess the details of the altered anatomy preoperatively to plan an appropriate approach. Intraoperatively, MR models were present in the surgeon's view without disturbing the endoscopic procedure. Intermittently, the surgeon could pull any of the models virtually present in the operating room, slice them, rotate them, and intricately study the alterations in a stepwise manner, as the surgery proceeds. Virtual reality and mixed reality-assisted powered endoscopic DCR can be an alternate approach reserved for extremely challenging cases of complex syndromic CNLDOs and post-traumatic SALDOs. Level 4 Laryngoscope, 2024.

Successful probing of Congenital Nasolacrimal Duct Obstruction on 11 years old child: A case report

Introduction : Congenital nasolacrimal duct obstruction (CNLDO) is a common cause of epiphora in infants; its prevalence rate of 5% to 20%, although only 2–6% will need intervention. The pathogenesis involves an imperforate membrane of the nasolacrimal duct but it may involve bony abnormalities and narrowing of the lacrimal drainage system.
 Case Illustration : An 11-year-old boy came to the hospital with complaints of a watery and excreted eye since he was born. On the dye disappearance test the result is +4. The patient was decided to have probing procedures. There was positive dye flow in the nasolacrimal duct after probing and irrigation with saline and dye. One week after the probing procedure, dye disappearance test was performed and the result is negative. Patients also no longer complain of watery and sticky eyes.
 Discussion : The management of CNLDO remains controversial. Probing can be used as a primary treatment for children <36 months of age, where success rate of 78–93% can be achieved. For older children success rate is even less. Studies on older children between 25 and 60 months have shown failure rates as high as 28%. The prevalence of complex obstruction in children between 49 and 60 months was 43% with a success rate of only 33% on probing.
 Conclusion : Appropriate time for probing the CNLDO is still under debate. The high success rate of probing in patients older than 2 years old confirm that the first intervention could be probing before considering complex intervention.

Successful probing of Congenital Nasolacrimal Duct Obstruction on 11 years old child: A case report

Introduction : Congenital nasolacrimal duct obstruction (CNLDO) is a common cause of epiphora in infants; its prevalence rate of 5% to 20%, although only 2–6% will need intervention. The pathogenesis involves an imperforate membrane of the nasolacrimal duct but it may involve bony abnormalities and narrowing of the lacrimal drainage system.
 Case Illustration : An 11-year-old boy came to the hospital with complaints of a watery and excreted eye since he was born. On the dye disappearance test the result is +4. The patient was decided to have probing procedures. There was positive dye flow in the nasolacrimal duct after probing and irrigation with saline and dye. One week after the probing procedure, dye disappearance test was performed and the result is negative. Patients also no longer complain of watery and sticky eyes.
 Discussion : The management of CNLDO remains controversial. Probing can be used as a primary treatment for children <36 months of age, where success rate of 78–93% can be achieved. For older children success rate is even less. Studies on older children between 25 and 60 months have shown failure rates as high as 28%. The prevalence of complex obstruction in children between 49 and 60 months was 43% with a success rate of only 33% on probing.
 Conclusion : Appropriate time for probing the CNLDO is still under debate. The high success rate of probing in patients older than 2 years old confirm that the first intervention could be probing before considering complex intervention.

Effectiveness and Timing of Congenital Nasolacrimal Duct Obstruction Probing: a Systematic Review

Abstract
 Introduction & Objectives : Most congenital nasolacrimal duct obstruction (NLDO) cases could resolve spontaneously or only require minimal conservative treatment. In unresolved cases, lacrimal probing is considered a primary treatment; however, no consensus on the best timing to perform probing is available. Therefore, this study aims to compare the effectiveness of immediate probing with deferred probing and to assess the best time to perform primary probing.
 Methods : A search for relevant literature was performed on four electronic databases: PubMed, Cochrane Library, EMBASE, and Scopus with predetermined keywords. The inclusion criteria consist of systematic reviews, RCTs, and prospective/retrospective studies published between 2013-2023 regarding lacrimal probing as an intervention for congenital NLDO.
 Results : We included seven studies. Three studies compared immediate and deferred probing, while four focused on the success rate of probing for NLDO at various age groups. Studies suggest immediate and deferred probing had a comparable effectivity in treating NLDO; however, one systematic review suggests immediate probing was superior to deferred probing. Studies also demonstrate that the success rate of probing declines with age. Lacrimal probing performed on NLDO patients under 12 months old had a success rate of more than 80%.
 Conclusion : Despite findings of comparable effectiveness between immediate and deferred probing, probing performed at a younger age yielded a higher success rate. This suggests that doctors should consider the patient's age at diagnosis to decide between immediate and deferred probing. Further evidence is needed to determine cut-offs for the best time to perform primary probing.

Lacrimal sac massage for congenital nasolacrimal duct obstruction: a multicentre randomised controlled trial

AimCongenital nasolacrimal duct obstruction (CNLDO) is the most common cause of epiphora and mucous discharge in the newborn. We conducted a multicentre randomised controlled trial to determine whether Crigler massage...

Bicanalicular silicone intubation versus probing for the treatment of congenital nasolacrimal duct obstruction in children older than 2 years

Background One of the most common conditions presenting to the oculoplastic clinic is congenital nasolacrimal duct obstruction (CNLDO), with an incidence of up to 20% in young children. Early probing as early as 18 months of age is usually associated with very good results. Conversely, the results of probing in older children and the need for intubation, either primary or secondary, are debatable in different studies. Purpose The aim of this study was to compare the outcome of probing versus primary intubation in children older than 2 years having CNLDO. Patients and methods This prospective cohort comparative study was carried out on 40 eyes of 36 children, aged 2–7 years of both sexes, with epiphora due to CNLDO. The eyes were divided into two groups: group A that included 20 eyes that underwent probing, and group B that included 20 eyes that underwent intubation in whom the tube was removed after 3 months. The enrolled children were subjected to local ophthalmological examination, eye lid examination, puncti evaluation, regurge test, nasal evaluation, lacrimal pathway evaluation, and computed tomography dacryocystography before the procedure and 3 months after the procedure. Results The intubation group (group B) was found to have a higher success rate (90%) compared to the probing group (group A) (80%), although the difference was statistically insignificant (P=0.661). On univariate regression analysis, age, contrast volume, and most dilated portion of the lacrimal sac before the procedure were significant predictors for the success rate (P<0.001). In addition, there was a significant relationship between the success rate and age, most dilated portion, and contrast volume after the procedure (P<0.001). Conclusion There was a high success rate for both probing and intubation in older children above 2 years suffering from CNLDO. Although intubation was found to have a higher success rate, the difference was statistically insignificant.

Surgical Outcomes in Congenital Nasolacrimal Duct Obstruction After Probing Failure: A One-Stage Approach.

This study evaluates the outcomes of a one-stage obstruction-based strategy for congenital nasolacrimal duct obstruction (CNLDO) in children who have prior probing failure. The objective is to assess the success rates of probing, balloon dacrioplasty (BDP), monocanalicular intubation (MCI), and external dacryocystorhinostomy (external DCR) performed in the same anesthesia session. A retrospective analysis included 55 eyes (45 patients, aged 12-120 months) with initial probing at another center. Procedures involved probing, probing plus BDP, MCI, and external DCR. For membranous obstruction (MO), the procedure concludes after probing; for incomplete complex obstruction (ICO) it includes BDP or MCI; and for complete complex obstruction (CCO), external DCR is performed. Success rates were assessed based on obstruction types and age groups, with improvement in symptoms and signs as the measure of success. Statistical analysis utilized Kruskal-Wallis, Fisher's exact test, and logistic regression. The overall success rate for all procedures was 72.7%. Success rates were 77.8% for MO, 66.7% for ICO, and 100% for CCO, introducing a promising perspective for the management of different CNLDO types. External DCR exhibited a 100% success rate, highlighting its effectiveness in cases of CCO. Success rates for interventions were 77.8% for probing, 61.5% for probing plus BDP, and 73.1% for MCI, emphasizing the feasibility and success of one-stage obstruction-based treatments. Age did not significantly correlate with success rates. The one-stage obstruction-based approach, which demonstrated favorable success rates in treating CNLDO and introduced a paradigm shift in the treatment strategy after probing failure, underscores the importance of tailoring interventions to the specific obstruction type. The study also highlights the feasibility and cost-effectiveness of performing multiple BDP, MCI, or external DCR procedures concurrently during the same anesthesia session, further emphasizing the crucial role of customizing treatments based on the nature of the obstruction.

Assessing the success rate of treatment in simple and complex congenital nasolacrimal duct obstruction: a systematic review and meta-analysis.

To assess and compare the success rate (SR) of probing and intubation in patients with congenital nasolacrimal duct obstruction (CNLDO). We conducted a literature search for identifying relevant studies published in English using PubMed, Google Scholar, Scopus, and Web of Science databases from the date of inception to Feb 2023. After extracting data, the SR was compared between the study groups: simple and complex CNLDO. To compare the treatment outcome, the mean difference of the SR was considered as the effect size. Random effects model or fixed effects model were performed for statistical inferences. A total of 21 studies were eligible to be analyzed. The pooled SR of treatment was 88% in simple, and 57% in complex CNLDO. Exerting intubation in increased the SR from 87% (SR of probing) to 92% in simple CNLDO which was not significant. However, compared to probing, intubation has a significantly higher SR in complex CNLDO (46 to 82%). While the SR of probing was significantly lower in complex CNLDO, the difference between the SR of intubation was not significant between groups. Although increasing the age does not have an adverse effect on the SR in simple CNDLO, it causes a significant decrease in the SR of complex group. This study revealed that even though the addition of NLD intubation does not provide significant benefits beyond probing alone for patients with simple CNLDO, in children with complex CNLDO, NLD intubation should be considered as a primary treatment due to its substantial increase in surgical success rates. Delaying the treatment would increase its success in patients with complex but not the simple CNLDO.

Bony Congenital Nasolacrimal Duct Obstruction: A Novel Phenotype of Aplasia of Lacrimal and Major Salivary Glands

PurposeAplasia of lacrimal and salivary gland (ALSG) is a syndromic disorder characterized by aplasia of lacrimal and salivary systems. Reported ophthalmic manifestations of ALSG include aplasia of lacrimal glands, punctal agenesis, lacrimal sac mucocele and membranous congenital nasolacrimal duct obstruction (CNLDO). Bony CNLDO, a rare cause of congenital epiphora, has not been associated with any syndromic disorder. This study investigated the relationship between genetic mutations and bony CNLDO in three Chinese families with ALSG. DesignSingle-center observational case study. ParticipantsThree Chinese families with bony CNLDO including 7 affected and 9 healthy family members. MethodsSlit-lamp ophthalmic examination, comprehensive physical examination, orbital Computed Tomography (CT), cervicofacial Magnetic Resonance Imaging (MRI), audiometry and whole exome sequencing on periphery blood were performed. Variants were cross-referenced with 1000 control genomes and various population databases. Pathologic variants were identified using bioinformatic tools. Main Outcome MeasuresClinical examination, diagnostic imaging, whole exome sequencing and bioinformatic analysis findings. ResultsAffected patients had decreased tear production on Schimer I Test and reduced tear break-up time. Bony CNLDO was observed on computed tomography, showing unilateral or bilateral bony termination at the middle or terminal segment of the nasolacrimal canal. Cervicofacial MRI showed aplasia or absence of lacrimal, parotid and submandibular glands. Physical examination revealed normal ears, digits and facial morphology. Audiometry and dental assessment were conducted on the pediatric patients and yielded normal results. The clinical characteristic of patients aligned with diagnosis of ALSG. Genomic analysis revealed three novel heterozygous missense mutations of Fgf10 gene: c.316T>C, c.327C>G, c.332T>G. The inheritance pattern was autosomal dominant with variable penetrance. These variants were not observed in 1000 control chromosomes and population databases. These variant positions were also shown to be highly conversed across various animal species. Mutated genes and proteins were predicted as “deleterious” with most computational models with a few suggesting they may be “benign”. ConclusionsBony CNLDO was identified as a novel phenotype of ALSG implicated by missense mutations of highly conserved residues in the Fgf10 gene. These cases broadened our knowledge of Fgf10-related phenotypes and prompt clinicians to consider syndromic associations in patients with bony CNLDO.

Comparison of Outcomes of Silicone Tube Intubation with or without Dacryoendoscopy for the Treatment of Congenital Nasolacrimal Duct Obstruction

In this retrospective study, we compared and analyzed two groups of patients who underwent silicone tube intubation (STI) to treat congenital nasolacrimal duct obstruction (CNDO). We employed dacryoendoscopy to visualize the lacrimal pathways of one group. In total, 85 eyes of 69 patients were included (52 of 41 patients in the non-dacryoendoscopy and 33 eyes of 28 patients in the dacryoendoscopy group). Clinical characteristics, dacryoendoscopic findings, and surgical outcomes were evaluated. The overall STI success rate was 91.8%, and the success rate was significantly higher in the dacryoendoscopy versus non-dacryoendoscopy group (97.0% and 88.5%, respectively). For patients < 36 months of age, the success rate was 100% (23 eyes). All patients with Hasner valve membranous obstructions were younger than 36 months and had structural obstructions of the lacrimal drainage system (LDS) (p = 0.04). However, in patients lacking Hasner valve obstructions, LDS secretory (50.0%) and structural (50%) obstructions occurred at similar rates, which did not vary by age. Dacryoendoscopy-assisted STI enhanced the therapeutic efficacy of CNDO and identified diverse CNDO etiologies beyond Hasner valve obstructions. These findings emphasize the potential advantages of dacryoendoscopy in surgical treatment for CNDO patients.

Assessment of Office-Based Probing with Dacryoendoscopy for Treatment of Congenital Nasolacrimal Duct Obstruction: A Retrospective Study.

We aimed to evaluate the safety and efficacy of office-based probing with dacryoendoscopy under local anesthesia for congenital nasolacrimal duct obstruction (CNLDO). This single-institution study retrospectively reviewed data on 72 eyes of 64 consecutive children (38 boys, 43 eyes; 26 girls, 29 eyes), aged between 6 and 17 (mean age: 10.0 ± 2.7) months with suspected CNLDO, from July 2016 to February 2022. These patients underwent probing with dacryoendoscopy under local anesthesia. CNLDO was diagnosed clinically based on the presence of epiphora and sticky eyes due to mucous discharge commencing within the first 3 months of life, increased tear meniscus height, and fluorescein dye disappearance test results. A total of 63 of the 72 eyes had narrowly defined CNLDO, and 9 eyes had other types of obstructions. The intervention success rate was 100% (63/63 eyes) for patients with typical CNLDO and 97.2% (70/72 eyes) for the entire study cohort. Moreover, CNLDO was classified into five types based on the features of the distal end of the nasolacrimal duct. Probing with dacryoendoscopy is safe and yields a high success rate in pediatric patients with CNLDO. This is the first study to assess the safety and efficacy of probing with dacryoendoscopy under local anesthesia in pediatric patients with CNLDO.

High incidence and recurrence of tympanostomy tube procedures in children who underwent nasolacrimal duct probe and intubation for congenital nasolacrimal duct obstruction

To determine the incidence of tympanostomy tube (T-tube) insertion in children who required probing and intubation for congenital nasolacrimal duct obstruction (CNLDO) at a single academic institution and to analyze success rates. The medical records of 92 patients who underwent nasolacrimal probing and intubation for CNLDO over a 9-year period were reviewed retrospectively. A preoperative questionnaire was given to the patient's guardian concerning laterality of CNLDO, history of otitis media (OM) antibiotic therapy, history of T-tube placement and number placed. At least 12 months following the initial nasolacrimal duct P&I, a second questionnaire was administered regarding resolution of CNLDO symptoms, additional measures taken to relieve postoperative symptoms if present, and any further history regarding OM episodes or T-tube insertion. Of the 92 children with CNLDO, 37 (40%) required T-tubes either prior to or following nasolacrimal duct probing and intubation, a rate higher than in the general population (P < 0.00001). 21 (56%) of CNLDO probing and intubation patients who required T-tubes required at least two sets, at different times, to relieve OM symptoms. Six of 37 patients (16%) with a history of T-tube placement and 1 of 55 (2%) with no history of T-tube placement had persistent epiphora after nasolacrimal probing and intubation (relative risk, 8.92; P = 0.0388). In our study cohort, pediatric patients with CNLDO who required nasolacrimal probing and intubation were at higher risk of needing T-tubes for chronic OM than the general population, and those needing T-tubes were at increased risk of residual epiphora.

Anisometropia and Amblyopia Outcomes in Early Versus Late Resolution of Congenital Nasolacrimal Duct Obstruction in Older Infants.

Congenital nasolacrimal duct obstruction is a known risk factor for amblyopia and anisometropia. The purpose of this study was to investigate whether the rate of anisometropia and amblyopia development differed based on the age at CNLDO resolution in older infants. This retrospective chart review at a single tertiary children's hospital from 2007 to 2017 compared early versus late spontaneous resolution (cutoff 12 months) and intervention (cutoff 15 months) groups presenting at ≥9 months of age, comparing visual outcomes, including anisometropia (≥1 D of sphere or cylinder) and amblyopia (≥2 levels difference in Teller acuity or optotype testing). Parents/guardians were contacted by phone for missing data on spontaneous resolution or intervention status. A total of 462 patients were included (152 early; 310 late group). The early group presented at a median age of 12.0 (interquartile range: 10.0, 13.0) months, while the late group presented at 21.0 (interquartile range: 15.0, 32.0) months. Unilateral disease occurred in 62% and 59%, respectively. Anisometropia was seen in (12/102) 12% of early versus (25/243) 10% of late patients (p = 0.686, 95% CI: -0.059, 0.088), and amblyopia in (4/131) 3% of early versus (14/286) 5% of late patients (p = 0.322, 95% CI: -0.061, 0.018). In patients presenting <24 months without undergoing surgery, spontaneous resolution occurred in 76% between 12 and 24 months (n = 41). Anisometropia and amblyopia rates did not significantly differ between early and delayed intervention for congenital nasolacrimal duct obstruction in this retrospective cohort presenting beyond 9 months of age to a children's hospital. This study found frequent late spontaneous resolution.

Preferred Practice Patterns of Congenital Nasolacrimal Duct Obstruction in Jordan.

Congenital nasolacrimal duct obstruction (CNLDO) is fairly common in newborns. The main aim of this cross-sectional study is to assess the preferred practice patterns of CNLDO among ophthalmologists in Jordan. This cross-sectional study was conducted across all ophthalmological practices in Jordan, using convenience sampling. An online questionnaire, designed through Google Forms, was distributed through social media. The survey contained four domains: baseline characteristics of participants and the diagnosis (7 items), medical management (3 items), and surgical management (11 items) of CNLDO. Descriptive statistics were conducted using SPSS (IBM SPSS Corp, SPSS Statistics ver. 26, USA). Eighty-three physicians responded to the survey, with an average age of 40.6 ± 8.6. More than half of the participants (53.0%, n = 44) were general ophthalmologists. Only 37.3% of our sample (n = 31) regularly evaluated the refraction of a child presenting with epiphora suggestive of CNLDO. Criggler's nasolacrimal duct massage was recommended by 62.7% of respondents (n = 52) for up to 12 months. In addition, 72.3% of respondents (n = 60) recommended 12 months as the minimum age for primary probing of CNLDO. Silicon intubation was considered for primary probing starting at 24 months by 31.3% of ophthalmologists (n = 20). Monocanalicular stent was preferred by 42.2% of respondents (n = 27) while 31.3% (n = 20) preferred bicanalicular stent. There is considerable variability in preferred practice patterns regarding the diagnosis and management of CNLDO in Jordan. Our findings highlight the gaps in optimum practices which need to be addressed for better management.