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Abstract
Purpose
The treatments for congenital nasolacrimal duct obstruction range from minimally invasive to more invasive methods. Initially, clinicians select lacrimal sac massage with topical antibiotics application or early lacrimal sac probing. We studied if the characteristics of infants improved after lacrimal sac massage with topical antibiotic application.
Methods
Two hundred thirty-four eyes of 204 patients diagnosed with congenital nasolacrimal duct obstruction from March 2001 to January 2007 were included. Excluded were infants who had obvious epiblepharon or eyelid abnormalities, tumors of the lacrimal system, or a history of trauma. Neonates less than 1 month were also excluded to rule out neonatal conjunctivitis. At the first visit, we recorded birth profile information such as gestational age, birth weight and height, onset time of symptoms, and post-conceptional age. We compared the results between the successful treatment group and failure group after lacrimal sac massage and topical antibiotic application.
Results
One hundred twenty-three eyes showed improvement after conservative treatment (52.6%), and the infants included in the success group visited earlier and had lower PCA ( P<0.05). No other factors evaluated in this study contributed toward the improvement in symptoms observed.
Conclusions
When considering treatment for congenital nasolacrimal duct obstruction, an evaluation of factors related to birth should be performed. According to the results, infants with the characteristics of favorable outcome should be treated conservatively, while those patients who do not have the characteristics for favorable outcome should be treated by early probing to achieve an effective and satisfactory outcome.
References
1. Paul TO, Shepherd R. Congenital nasolacrimal duct obstruction: natural history and the timing of optimal intervention. J Pediatr Ophthalmol Strabismus. 1994; 31:326–7.
2. Noda S, Hayasaka S, Setogawa T. Congenital nasolacrimal duct in Japanese infants : its incidence and treatment with massage. J Pediatr Ophthalmol Strabismus. 1991; 28:20–2.
3. Ffooks OO. Dacryocystitis in infancy. Br J Ophthalmol. 1962; 46:422–34.
4. Lee SY, Chung HS, Kim HB. . The incidence of congenital nasolacrimal duct in Korean neonates. J Korean Ophthalmol Soc. 1989; 30:5–8.
5. Duck-Elder S.System of ophthalmology. 1st ed. Vol. 3. St. Louis: C.V. Mosby Co.;1963. p. 241–5.
6. Duck-Elder S.System of ophthalmology. 1st ed. Vol. 3. St. Louis: C.V. Mosby Co.;1963; 923–41.
7. Sevel D. A reappraisal of the origin of human extraocular muscles. Ophthalmology. 1981; 88:1330–8.
8. Petersen RA, Robb RM. The natural course of congenital obstruction of the nasolacrimal duct. J Pediatr Ophthalmol Strabismus. 1978; 15:246–50.
9. Price HW. Dacryostenosis. J Pediatr. 1947; 30:302–5.
10. Crigler LW. The treatment of congenital dacryocystitis. JAMA. 1923; 81:23–4.
11. Kushner BJ. Congenital nasolacrimal system obstruction. Arch Ophthalmol. 1982; 100:597–600.
12. Ffooks OO. Lacrimal abscess in the newborn. Br J Ophthalmol. 1961; 45:562–5.
13. Katowitz JA, Welsh MG. Timing of initial probing and irrigation in congenital nasolacrimal duct obstruction. Ophthalmology. 1987; 94:698–705.
14. Robb RM. Success rates of nasolacrimal duct probing at time intervals after 1 year of age. Ophthalmology. 1997; 105:1307–10.
15. Moon JS, Choi WC. Lacrimal probing taken at outpatient department. J Korean Ophthalmol Soc. 1999; 40:2357–61.
16. Cassidy TC. Dacryocystitis in infancy. Am J Ophthalmol. 1948; 31:773–80.
17. Guerry D, Kendy EL. Congenital impotency of the nasolacrimal duct. Arch Ophthalmol. 1948; 39:193–204.
18. Sevel D. Development and congenital abnormalities of the nasolacrimal apparatus. J Pediatr Ophthalmol Strabismus. 1981; 18:13–9.
19. Jones LT, Wobrig JL. Surgery of the eyelids and lacrimal system, Birmingham:. Aesculapies Publishing Co. 1976; 157–73.
20. Wobig JL. Lacrimal probing complications. Ophthal Plast Reconstr Surg. 1985; 1:75–6.
Figure 1.
Crigler method lacrimal sac massage. (A) Apply eye ointment around the lacrimal fossa for lubrication. (B) Compress the common canalicular area with index finger. (C) Take the finger down while compressing strongly.
Table 1.
The rate of success and failure after lacrimal sac massage and topical antibiotics application and the factors affecting that in whole patients
| Factor | Classification | Success (n=123) (%) | Failure (n=111) (%) | p value |
|---|---|---|---|---|
| Sex | Male (n=128) | 72 (56.3) | 56 (43.7) | 0.134 |
| Female (n=106) | 51 (48.1) | 55 (51.9) | ||
| Age (Days) | < 90 (n=105) | 68 (64.8) | 37 (35.2) | <0.05† |
| ≥ 90 (n=129) | 55 (42.6) | 74 (57.4) | ||
| Birth weight (gm) | < 3200 (n=135) | 73 (54.1) | 62 (45.9) | 0.342 |
| ≥ 3200 (n=99) | 50 (50.5) | 49 (49.5) | ||
| Birth height (cm) | < 48 (n=75) | 45 (60.0) | 30 (40.0) | 0.18 |
| ≥ 48 (n=159) | 78 (49.1) | 81 (50.9) | ||
| Onset time (week) | < 1 (n=216) | 113 (52.3) | 103 (47.7) | 0.457 |
| ≥ 1 (n=18) | 10 (55.6) | 8 (44.4) | ||
| Gestational age (weeks) | < 39 (n=72) | 37 (51.4) | 35 (48.6) | 0.461 |
| ≥ 39 (n=162) | 86 (53.1) | 76 (46.9) | ||
| PCA* (days) | < 300 (n=100) | 68 (68.0) | 32 (32.0) | <0.05† |
| ≥ 300 (n=134) | 55 (41.0) | 79 (59.0) |
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