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Lim, Park, and Lew: Clinical Outcomes of Probing in Children with Congenital Nasolacrimal Duct Obstruction
Original Article

J Korean Ophthalmol Soc 2016;57(7):1031-1036.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.7.1031

Clinical Outcomes of Probing in Children with Congenital Nasolacrimal Duct Obstruction

Sung Woong Lim, MD, Jong Seo Park, MD, Helen Lew, MD

Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea

Address reprint requests to Helen Lew, MD Department of Ophthalmology, CHA Bundang Medical Center, #59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea Tel: 82-31-780-5330, Fax: 82-31-780-5333 E-mail: helenlew68@gmail.com

Received 30 December 2015       Accepted 16 June 2016

Copyright © 2016 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To determine the success rate of probing for the treatment of congenital nasolacrimal duct obstruction and to identify the clinical factors affecting the success rates.

Methods

The records of probing procedures from January 2005 to January 2015 were reviewed. The present study included 200 eyes of 174 patients with congenital nasolacrimal duct obstruction. Successful probing was defined as complete resolution of epiphora 3 months after treatment. Success rates were compared between the 2 groups in terms of sex, age, laterality, and previous probing.

Results

A total of 200 eyes of 174 children (109 eyes of 94 males and 91 eyes of 80 females; mean age, 7.51 ± 3.39 months) had undergone the probing procedure. The overall success rates of primary probing were 81.5%, with an 80.7% success rate in males (88 eyes of 109 eyes) and 82.5% in females (75 eyes of 91 eyes). Success rates were 83.5% for the 91 eyes in children aged 0 to 6 months, 80.0% for the 90 eyes in children 6 to 12 months, and 78.9% for the 19 eyes in children over 12 months. No statistical significances were found among age groups. The probability of treatment success was lower in bilateral disease (p < 0.05; 86.4–67.3%). Twenty-four of 37 eyes with unsuccessful primary probing underwent secondary probing, resulting in a 70.8% success rate. Silicone tube insertion was performed in 4 eyes repeatedly, however, the procedures were unsuccessful. The overall success rate was 90%.

Conclusions

The success rates among various age groups were not statistically significant. The probability of treatment success was lower in bilateral cases. Probing is an effective first-line treatment in children diagnosed with nasolacrimal duct obstruction. Close observation and appropriate treatment should be considered in patients with bilateral disease.

Keywords: Congenital nasolacrimal duct obstruction, Probing, Silicone tube intubation

References

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Figure 1.
Primary probing success rate according to laterality, age, sex. Success; as complete resolution of epiphora 3months after first probing. mo = months.
jkos-57-1031f1.tif
Figure 2.
Primary probing success rate according to laterality, age. Bilateral procedure; probing was performed at both nasolacrimal duct.
jkos-57-1031f2.tif
Figure 3.
Primary probing success rate of each eye. Success; as complete resolution of epiphora 3months after first probing.
jkos-57-1031f3.tif
Table 1.
Demographic/clinical characteristics in various age groups
  Group A (≤ 6 months) Group B (6 months < and ≤ 12 months) Group C (12 months <) Total p-value*
Age (years) 5.07 ± 1.31 8.37 ± 1.43 15.42 ± 2.54 7.51 ± 3.39  
Patient-level characteristics N = 80 N = 77 N = 17 174  
  Sex (male:female) 44:36 41:36 9:8 94:80 0.972
Eye-level characteristics N = 91 N = 90 N = 19 200  
  Laterality         0.674
    Unilateral (%) 69 (75.8) 64 (82.2) 15 (78.9) 148 (74)  
    Bilateral (%) 22 (24.2) 26 (17.8) 4 (21.1) 52 (26)  
  Previous massage (N = 48)         0.142
    Yes (%) 31 (34.1) 22 (24.4) 8 (42.1) 61 (30.5)  
    No (%) 10 (11.0) 9 (10.0) 3 (15.8) 22 (11.0)  
    Not known/no record 50 (54.9) 59 (65.6) 8 (42.1) 117 (58.5)  
  Epiphora present (N = 200) 91 90 19 200  
  Mucous discharge present (N = 59) 24 31 4 59  
Culture (N = 29)       16  
  Staphylococcus aureus       4  
  Streptococcus pneumoniae       4  
  Moraxella catahalis       4  
  Coagulase-Negative staphylococcus       4  

Values are presented as mean ± SD unless otherwise indicated.

* p-value less than 0.05 signifies a significant difference between group based on x2.

Table 2.
Association between probing time and laterality
At the time of procedure Bilateral (success, %) Unilateral (success, %) Total (success, %) p-value*
Group A (≤6 months) 17/22 (77.2) 59/69 (85.5) 76/91 (83.5) 0.22
Group B (6 <and ≤ 12 months) 14/26 (50) 58/64 (90.6) 72/90 (80) <0.05
Group C (12 months <) 4/4 (100) 11/15 (73.3) 15/19 (78.9) 5.30
Total 35/52 (67.3) 128/148 (86.4) 163/200 (81.5) <0.05

* p-value less than 0.05 signifies a significant difference between group based on Fisher's extract test.

Table 3.
Clinical outcome success according to baseline eye-level characteristics
  N Success (%) Relative risk for fail*
Sex      
  Male 109 88 (80.7) –
  Female 91 75 (82.4) 0.894
Age at probing      
  Group A (0 to ≤ 6 months) 91 76 (83.5) –
  Group B (6 to ≤ 12 months) 90 72 (80.0) 0.740
  Group C (12 months <) 19 15 (78.9) 0.938
Laterality      
  Unilateral 148 128 (86.4) –
  Bilateral 52 35 (67.3) 3.465
Total 200 163 (81.5)  

* Less than 0.05 signifies a significant difference between group based on binary logic regression.

Table 4.
Result of 200 eyes probing in various age groups
  Group A (≤ 6 months) (N = 91) Group B (6 < and ≤ 12 months) (N = 90) Group C (12 months <) (N = 19) Total (N = 200)
Successful primary probing 76 72 15 163
Primary success rate (%) 83.5 80 78.9 81.5
Receiving second probing 9 15 0 24
Successful second probing 8 9 0 17
Second success rate (%) 88.9 60 0 70.8
Total successful probings 84 81 15 180
Total success rate (%) 92.3 90 78.9 90
Receiving silicone tube intubation 3 1 0
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