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    Endoscopy can aid treatment of pediatric nasolacrimal duct obstruction

    Cycloplegic refraction beneficial for patients at initial, follow-up exams

     

    Symptom-based treatment

    The latest data suggest symptom-based treatment. If the child has a weepy eye without infection, wait for the blockage to clear spontaneously during the first year. If the child has repeated infections and requires repeated courses of antibiotics, early intervention may be recommended. If the blockage persists beyond the first birthday, it is time to intervene.

    “Once you make the decision to intervene, the question is how and where you do it,” Dr. Silkiss said. “The data show that if you probe every child with PNLDO at 6 months in the office, you have 92% success at 18 months. The results are great, but two-thirds of those children didn’t need to be probed because they would have resolved on their own.”

    Primary probing with intubation can also produce good results. Reported success rates range from 90% to 96% depending on the study and age at treatment. Primary balloon dacryoplasty has a success rate of 80% and is significantly more costly than intubation, $350 for the balloon compared to $80 for a silicone tube.

    While NLD probing and intubation are more successful and less costly than balloon dacroplasty, primary probing is not always successful.

    Probing is blind and the probe may go astray. Some ducts fail to open through the nasal mucosa and some ducts extend lateral to the nasal mucosa or to the floor. Some children have no duct at all or have a bony obstruction. The anterior end of the inferior turbinate may be impacted or there may be craniofacial anomalies leading to obstruction.

    “You can’t clear what you can’t visualize in these complex situations,” Dr. Silkiss said. “Baby noses are very tiny and when you try to look into the nose using traditional approaches, you can’t see very much. Leveraging new technologies such as endoscopy has dramatically improved outcomes for these children, especially those previously considered difficult to treat.”

    Endoscopic surgery success rate

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