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Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction
Published on: October 13, 2017
Endoscopic dacryocystorhinostomy in children
D K Vanderveen1, D T Jones, H Tan
1Department of Ophthalmology, Children's Hospital, Boston, Massachusetts, USA. deborah.vanderveen@tch.harvard.edu
Insights
Endoscopic dacryocystorhinostomy (DCR) effectively treats persistent nasolacrimal duct obstruction (NLDO) in children when other methods fail. This minimally invasive approach offers a safe and scarless alternative for pediatric patients.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Otolaryngology
Background:
- Persistent nasolacrimal duct obstruction (NLDO) often necessitates surgical intervention.
- Traditional external dacryocystorhinostomy (DCR) is effective but results in scarring and is often avoided in children.
- Endoscopic DCR offers a less invasive alternative.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic DCR in pediatric patients with persistent NLDO.
- To assess the success rate of endoscopic DCR after failed initial treatments.
Main Methods:
- Retrospective review of endoscopic lacrimal procedures over 3 years.
- Seventeen children (22 ducts) with persistent NLDO underwent endoscopic DCR after failed probing/intubation.
- Success defined by resolution of symptoms; follow-up ranged from 6 to 36 months.
Main Results:
- 88% of patients experienced complete resolution of tearing and discharge.
- Two patients required revision endoscopic DCR for recurrent symptoms.
- No complications were reported during the study period.
Conclusions:
- Endoscopic DCR is a safe and effective treatment for persistent NLDO in pediatric patients unresponsive to simpler procedures.
- The combined ophthalmology-otolaryngology endoscopic approach provides a successful alternative to external DCR.
- This technique is particularly beneficial for distal obstructions in children, avoiding external scarring.
Background:
Persistent nasolacrimal duct obstruction (NLDO) often requires treatment by probing, intubation, or balloon dacryoplasty. Refractory cases have been managed by external dacryocystorhinostomy (DCR), which leaves a scar; however, this procedure is generally avoided in young children. Endoscopic DCR has been successfully performed in adults and described in children. We report the success of this procedure in a series of pediatric patients.
Methods:
A retrospective review of all endoscopic lacrimal procedures performed in a 3-year period was undertaken. Seventeen children (22 ducts) with persistent NLDO after at least one failed probing, with or without silicone tube placement, underwent endoscopic DCR. Follow-up ranged from 6 to 36 months, and success was defined as resolution of tearing and discharge by follow-up clinical evaluation and by parental history.
Results:
All but 2 patients (88%) with NLDO showed complete resolution of tearing and discharge. These 2 patients had recurrent symptoms after the Crawford tubes were removed and required revision endoscopic DCR. No complications from this procedure were noted.
Conclusions:
Endoscopic DCR is a safe and effective means of treating persistent NLDO in infants and young children when simple probing, intubation, or balloon procedures have failed. The team ophthalmology-otolaryngology endoscopic approach provides a highly successful alternative for patients with a persistent distal obstruction that might otherwise require an external procedure.
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