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A multidisciplinary approach to atypical lacrimal obstruction in childhood
J F Wong1, J J Woog, M J Cunningham
1Department of Ophthalmology, New England Medical Center, Boston, Massachusetts, USA.
Insights
Endoscopic surgery effectively treats unusual childhood lacrimal outflow obstructions, including distal nasolacrimal duct cysts and persistent dacryocystitis. This approach offers symptom improvement with good patient tolerance.
Area of Science:
- Ophthalmology
- Pediatric Otolaryngology
- Medical Imaging
Background:
- Pediatric lacrimal outflow anomalies present diagnostic and management challenges.
- Atypical presentations require specialized approaches beyond standard probing or intubation.
Purpose of the Study:
- To explore the diagnosis and management of rare childhood anomalies affecting the lacrimal system, nasal cavity, and sinuses.
- To evaluate the efficacy of endoscopic techniques in treating these complex pediatric cases.
Main Methods:
- Retrospective case series of eight children with diverse lacrimal outflow anomalies.
- Utilized intranasal endoscopy and dacryocystography (DCG) for diagnosis.
- Surgical interventions included endoscopic cyst resection, dacryocystorhinostomy (DCR), and lacrimal intubation.
Main Results:
- Endoscopic dacryocystorhinostomy (DCR) and cyst resection were performed.
- Monocanalicular or bicanalicular intubation was utilized for the lacrimal outflow system.
- All patients tolerated endoscopic surgery well, with significant symptom improvement.
Conclusions:
- Endoscopic techniques demonstrate promise for managing atypical pediatric lacrimal outflow obstructions.
- This approach offers a minimally invasive option for complex cases.
- Further investigation into endoscopic management of these anomalies is warranted.
Purpose:
This study explores the diagnosis and management of unusual anomalies involving the canaliculi, nasolacrimal duct, nasal cavity, and sinuses in childhood.
Methods:
A case series of eight children with lacrimal outflow anomalies ranging from distal nasolacrimal duct cyst formation to persistent dacryocystitis following failed probing or silicone intubation were reviewed retrospectively. Diagnostic studies including intranasal endoscopy and preoperative or intraoperative dacryocystography (DCG) were of value.
Results:
Treatment modalities included endoscopically guided resection of lacrimal cyst mucosa, endoscopic dacryocystorhinostomy (DCR), and monocanalicular or bicanalicular intubation of the lacrimal outflow system. In our series, endoscopic surgery was well tolerated by all patients with improvement in symptoms.
Conclusions:
This initial experience suggests that endoscopic techniques may be useful in the management of atypical lacrimal outflow obstruction in childhood.