Abdul Qayyum, Manzoor Ahmed, Imran Khan Bazai.
Early Probing in Nasolacrimal Duct Obstruction in Infants and Children.
Ophthalmol Update Jan ;13(1):4-6.

Purpose: To evaluate the results of management of nasolacrimal duct impatency in infants and children to compare results of conservative therapy and surgical probing and irrigation. Material & Methods: All the patients were enrolled from the out patients department of Pediatric Ophthalmology, Bolan Medical College Quetta. A Total of 5110 patients were examined during the period from January 2013 to June 2014. Out of these, 97 patients (1.9%) were found to be suffering from congenital nasolacrimal duct obstruction, of these 76 patients (78%) had unilateral obstruction, while 21 patients (22%) had bilateral obstruction. On first visit these patients were kept on conservative treatments (topical antibiotics) and their parents were instructed about the hydrostatic massage at the lacrimal sac area. These patients were re-examined after two to three weeks, if there was no improvement, the patient was either treated surgically, when more than six months of age or the medical treatment was continued when the patient was under the age of six months. In infants older than six months who did not respond to conservative treatment, the probing and syringing were performed. This procedure was performed using a halothane general anesthesia. The lower punctum was dilated with punctum dilator then the passages were irrigated with saline to wash out any debris, using the 23 gauge lacrimal cannula on a syringe. The lacrimal probe size 0 or 1 was used (depending on the age of patients). The lacrimal probe was lubricated with antibiotic ointment. The probe was initially passed vertically, then horizontally and finally downwards and slightly posteriorly. The obstruction was usually felt when 3/4th of probe was inside the passage. It was then taken out and syringing repeated. Topical antibiotics were instilled .The patients were advised to continue treatment for another two weeks, then the patient were re-examined to re-evaluate the results of the surgical procedure after two weeks. Results: 63 patients (65%) had spontaneous relief from tearing and discharge with medical treatment and massage. These include 47 patients (75%) among the 0-6 months age group, 13 patients (20%) among the 7-12 months age group and 5 patients (5%) among the above one year age group (Table-1). 34 patients (35%) required probing. No patient was probed before 6 months of age. Probing cured tearing and discharged in 27 patients (79%) while 7 patients (21%) required repeat probing. Second probing relieved 5 patients (14%) of epiphora & discharge. 2 patients who were older than 1 year remained symptomatic even after 3rd repeat probing (Table-2). Conclusion: All the patients with congenital nasolacrimal duct obstruction should be conservatively treated with antibiotics and hydrostatic massage up to the age of six months. If not relieved with above measures, careful probing may be performed before the infant is one year of the age to achieve excellent results.

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