Dacryocystorhinostomy In Children Research Articles

Current management strategies of congenital nasolacrimal duct obstructions

ABSTRACT Introduction: Congenital nasolacrimal duct obstruction (CNLDO) is characterized by epiphora starting in the first two weeks after birth, representing 90% of the causes of epiphora in childhood. The purpose of this article is to provide information about the main aspects of this important entity. Method: This is an extensive database search, including articles about causes of epiphora in newborns, clinical diagnosis, types and treatments of CNLDO, exploring conservative (massage and antibiotics), or invasive treatment (probing, intubation, balloon catheter dilatation, dacryocystorhinostomy) as well the use of adjuvant treatment. Results: Despite the many controversies related to the CNLDO treatment, the decisions must be based on the natural history of the affection, type of obstruction, and clinical manifestation. Recognizing the types of obstruction (simples or complex) can facilitate choosing the adequate treatment. Nasal endoscopy is the most important tool for CNLDO diagnosis and management, mainly in complex cases, highlighting the variants of CNLDO, optimizing management to achieve better success rates. Endoscopic dacryocystorhinostomy in children can also provide a very good outcome. Conclusion: Simple CNLDO can have a spontaneous resolution or evolve to cure with a massage. However, complex CNLDO must have more attention. Endoscopy can document the efficacy of sondage and provide the opportunity to treat associated nasal alterations detected during the procedure, improving the outcome.

The outcomes of 326 external dacryocystorhinostomy operations in children with dacryostenosis - 30-year experience of an oculoplastic surgeon.

To report demographic features and surgical outcomes of 320 children undergoing external dacryocystorhinostomy for dacryostenosis. We performed a retrospective evaluation of the records of patients aged <16 years who underwent external dacryocystorhinostomy. Patient demographic features and success rates of the operations were analyzed from the data records. Children with <12-month follow-up were not enrolled in the study. We identified 326 operative records of 320 children (162 [50.6%] girls and 158 [49.4%] boys) who underwent external dacryocystorhinostomy with a mean follow-up of 26.03 ± 11.11 months. Overall, we evaluated 116 (35.6%) cases of congenital nasolacrimal duct obstruction. Our series demonstrated a 99.4% success rate for external dacryocystorhinostomy. External dacryocystorhinostomy in children has a high success rate if performed by an experienced oculoplastic surgeon.

No more scope, scar, or tears: non-endoscopic endonasal dacryocystorhinostomy in children

No more scope, scar, or tears: non-endoscopic endonasal dacryocystorhinostomy in children

Results of endonasal dacryocystorhinostomy in pediatric patients.

We conducted a prospective interventional study to evaluate the role of endoscopic endonasal dacryocystorhinostomy in children. Our study population was made up of 20 patients-18 boys and 2 girls, aged 2 to 12 years (mean: 5.3)-who presented with signs and symptoms suggestive of nasolacrimal duct blockage that was refractory to conventional medical treatment. In all cases, blockage was confirmed by nasolacrimal duct syringing that demonstrated regurgitation from the opposite punctum. The primary outcome measures for success were resolution of symptoms and duct patency on lacrimal irrigation. At 6 months, 17 patients (85%) experienced complete symptomatic relief, 1 (5%) had partial relief, and 2 (10%) reported no relief. Moreover, the nasolacrimal duct was patent in 17 patients, partially patent in 2, and blocked in 1. We conclude that endoscopic endonasal dacryocystorhinostomy is a safe and effective procedure in children with nasolacrimal duct blockage when medical therapy and probing have been unsuccessful.

Pediatric Endoscopic Dacryocystorhinostomy

This is a case series with chart review from 1997 to 2010 to determine results of endoscopic dacryocystorhinostomy in children. Thirty-seven children underwent removal of the medial wall (RMW) of the lacrimal sac (LS) and 2 had lacrimal stents inserted because they had external fistulae and small cicatrized LS. Parameters of success were (1) resolution of epiphora, (2) no further attacks of dacryocystitis, and (3) patency of neofistula. Of the 37 (95%) children who had RMW of the LS, 34 (92%) were patent after 12 weeks and were considered successful. Three (8%) neofistulae obstructed within 2 weeks and needed revision, and 2 (5%) patients had small cicatrized LS along with fistula and were stented. The fistulae closed down in 4 weeks. However, when the stents were removed 6 weeks later, epiphora returned. The authors' experience reveals that removal of the medial wall of the LS is effective in stopping chronic epiphora.

Balloon Catheter Dilation for Complex Congenital Nasolacrimal Duct Obstruction in Older Children

To evaluate the effectiveness of lacrimal balloon catheter dilation in the treatment of complex congenital nasolacrimal duct obstruction in older children. In a retrospective study, the case records of 65 eyes of 59 children 2 to 6 years (mean: 37 months) who underwent probing for congenital nasolacrimal duct obstruction were evaluated. Complex obstruction was noted in 21 (32.3%) of the 65 children older than 2 years who underwent probing. Secondary balloon dacryoplasty was performed in 8 (38.09%) of these 21 lacrimal systems. Patient age ranged from 3 to 6 years (mean: 47 months). Balloon catheter dilation was performed according to a standard protocol. Clinical patency of the nasolacrimal system was the main outcome measure and was defined as complete resolution of signs and symptoms (crusting, discharge, and watering) on follow-up. The procedures were performed under general anesthesia. All dilations were performed by the same lacrimal surgeon. Secondary balloon dacryoplasty was successful in seven of the eight lacrimal systems (87.5%). Complex obstruction at the distal end of the nasolacrimal duct was noted in all children. All children were older than 3 years (mean: 37 months), and all underwent secondary procedures because previous probing was unsuccessful. Balloon catheter dilation is an effective procedure for complex nasolacrimal duct obstruction in older children. It can be an alternative to silicone intubation and dacryocystorhinostomy in children after unsuccessful probing.

Neonatal respiratory distress secondary to bilateral intranasal dacryocystocoeles

Obstruction of the nasolacrimal duct is a common congenital abnormality reported in up to 84% of neonatal patients [J. Yohendran, A.C. Wignall, E.J. Beckenham, Bilateral congenital dacryocystocoeles with concurrent intranasal mucocoeles causing respiratory distress in a neonate, Asian J. Surg. 29 (2) (2006) 109-111; M.J. Cunningham, J.J. Woog, Endonasal endoscopic dacryocystorhinostomy in children, Arch. Otolaryngol. Head Neck Surg. 124 (1998) 328-333; D. Guery, E.L. Kendig, Congenital impotency of the nasolacrimal duct, Arch. Ophthalmol. 97 (1979) 1656-1658]. Rarely, obstruction results in the development of an intranasal lacrimal duct cyst, or dacryocystocoele, which arises inferolateral to the inferior turbinate [H.R. Jin, S.O. Shin, Endoscopic marsupialisation of bilateral lacrimal sac mucoceles with nasolacrimal duct cysts, Auris Nasus Larynx 26 (1999) 441-445]. These lesions can cause nasal obstruction and, when bilateral, significant respiratory compromise. We present the case of a 3-day-old infant with bilateral intranasal lacrimal duct cysts causing nasal obstruction and intermittent respiratory compromise. The diagnosis was suspected on clinical examination and confirmed on MRI. The patient was successfully managed by bilateral endoscopic marsupialisation and probing of the nasolacrimal ducts. We also present a review of the literature surrounding investigation and management of intranasal lacrimal duct cysts.

Lacrimal drainage obstruction and dacryocystorhinostomy in children

To determine the outcome of dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction (NLDO) in children. A review of medical records of 104 cases (82 patients) of paediatric DCR who underwent DCR at the Sydney Eye Hospital from 1995 to 2004. The main outcome measures included post-operative symptomatic relief of presenting symptoms, complications, subjective visibility of any scar, and general satisfaction. Statistical methods included chi(2) tests, and Student's t-tests for the comparison of variables among groups. Ninety-four external, 10 endoscopic primary procedures, and five revision procedures were included. Fifty-six of the cases were primary NLDO, and 48 were secondary NLDO. The mean follow-up was 1.44 years. Average age at surgery was 6.6+/-4.2 years (mean+/-SD). Ninety-one eyes needed DCR for the involvement of the lower lacrimal outflow system, and 13 eyes were NLDO associated with congenital punctual/canalicular dysgenesis.Most of the complications of external DCR were related to Jones tube placement. Five cases (4.8%) needed DCR revision. There was a significantly higher incidence of revision surgery in the non-stented group (P<0.01), and the Jones tube group (P<0.001) as compared with the silicone intubation stent group. External DCRs have acceptable long-term clinical and cosmetic results, and low post-operative complication rate. Cases with punctal stenosis or those requiring Jones tube insertion are associated with a higher complication rate. Silicone intubation is associated with a lower need for operative revision.

Primary endoscopic dacryocystorhinostomy in children—Analysis of 18 patients

To describe the technique and results of primary endonasal endoscopic dacryocystorhinostomy in children with nasolacrimal duct blockage and review of literature with comparison of the results in adults. A prospective study was carried out between the months of January 2002 to December 2004, which included 18 patients. Patients diagnosed as having only nasolacrimal duct obstruction were included in this study and an endonasal endoscopic procedure was performed. Eighteen children underwent endoscopic the DCR procedure. There were 5 males (27.7%) and 13 females (72.3%) with the maximum incidence between the age group of 4-7 years (age ranging from 10 months to 11.2 years). The follow up period ranged from 6 to 19 months average being 8.2 months. Relief of symptoms and endoscopic visualization of the patent stoma made into the lacrimal sac with sac syringing determined a successful outcome. Seventeen patients (94.4%) fulfilled the criteria. Our experience suggests that endonasal endoscopic DCR without stenting offers the same success rates for primary surgery over external DCR as have been established in adults. Moreover, it has an added advantage of shorter operative time, less morbidity and avoidance of stent related complications.

Dacriocistorrinostomia endonasal em crianças

OBJETIVO: Nosso objetivo foi verificar se os resultados com a dacriocistorrinostomia endonasal endoscópica em crianças com obstrução do canal nasolacrimal permitem considerá-la uma alternativa de tratamento aceitável para crianças. FORMA DE ESTUDO: clínico com coorte transversal. MATERIAL E MÉTODO: Vinte e sete dacriocistorrinostomias endonasais endoscópicas foram realizadas em crianças de 2 a 12 anos com obstrução do canal nasolacrimal. Todas as crianças haviam sido tratadas por sondagem lacrimal, sem resultado. A técnica utilizou uncinectomia e uma abertura do saco lacrimal pequena. O seguimento foi de 3 meses. RESULTADOS: Bom resultado foi verificado após 21 cirurgias (77,8% de sucesso). A única complicação verificada foi prolapso da intubação com silicone em 1 caso. CONCLUSÃO: Nossos resultados permitem confirmar a dacriocistorrinostomia endonasal endoscópica como alternativa válida e segura para o tratamento de crianças com obstrução nasolacrimal resistente a sondagens.

Endonasal dacryocystorhinostomy in children

SummaryAimTo verify whether our results with endonasal endoscopic dacryocystorhinostomy in children with nasolacrimal duct obstruction allow us to consider this technique a valid treatment alternative for children.Study designclinical with transversal cohort.Material and MethodTwenty-seven endoscopic endonasal dacryocystorhinostomies were performed in children 2 to 12 years of age for nasolacrimal duct obstruction. Previous probings in all patients were unsuccessful. The technique employed uncinectomy and a small lacrimal sac opening. Follow-up time was 3 months.ResultsTwenty-one surgeries (77,8%) were successful. The only complication was silicone prolapse in one case.ConclusionOur results confirm endoscopic endonasal dacryocystorhinostomy as an acceptable and safe method for treating children with nasolacrimal duct obstructions that are resistant to probings.

Obstruction of the lacrimal drainage system.

This review covers evolving concepts in lacrimal outflow obstruction. Recent studies have increased our understanding of the surgical anatomy and pathophysiology of the lacrimal drainage system through radiologic, clinical, and microbiologic techniques. While external dacryocystorhinostomy remains an important treatment for nasolacrimal duct obstruction, there have been a number of therapeutic developments worthy of review, including advances in endoscopic and transcanalicular dacryocystorhinostomy, conjunctivodacryocystorhinostomy, and the use of mitomycin C in these procedures. In addition, we summarize recent advances in minimally invasive techniques for lacrimal outflow obstruction, including balloon dacryocystoplasty, lacrimal stents, and conjunctivoplasty. Finally, the roles of probing versus irrigation, nasal endoscopy, and endoscopic dacryocystorhinostomy in children are discussed.

Endoscopic dacryocystorhinostomy in children

Background: Persistent nasolacrimal duct obstruction (NLDO) often requires treatment by probing, intubation, or balloon dacryoplasty. Refractory cases have been managed by external dacryocystorhinostomy (DCR), which leaves a scar; however, this procedure is generally avoided in young children. Endoscopic DCR has been successfully performed in adults and described in children. We report the success of this procedure in a series of pediatric patients. Methods: A retrospective review of all endoscopic lacrimal procedures performed in a 3-year period was undertaken. Seventeen children (22 ducts) with persistent NLDO after at least one failed probing, with or without silicone tube placement, underwent endoscopic DCR. Follow-up ranged from 6 to 36 months, and success was defined as resolution of tearing and discharge by follow-up clinical evaluation and by parental history. Results: All but 2 patients (88%) with NLDO showed complete resolution of tearing and discharge. These 2 patients had recurrent symptoms after the Crawford tubes were removed and required revision endoscopic DCR. No complications from this procedure were noted. Conclusions: Endoscopic DCR is a safe and effective means of treating persistent NLDO in infants and young children when simple probing, intubation, or balloon procedures have failed. The team ophthalmology-otolaryngology endoscopic approach provides a highly successful alternative for patients with a persistent distal obstruction that might otherwise require an external procedure. (J AAPOS 2001;5:143-7)

Dacryocystorhinostomy in children and infants.

Dacryocystorhinostomy in children and infants.