Management of unilateral versus bilateral lacrimal drainage system dysfunction in Down syndrome

To evaluate treatment outcomes of unilateral versus bilateral congenital nasolacrimal duct (NLD) obstruction in patients with Down syndrome and highlight the effect of associated features that could result in poor outcomes.

A total of 34 lacrimal drainage systems (LDSs) were treated in 22 patients with Down syndrome who had a mean age of 47 (± 41.8) months. Charts of patients with Down syndrome with congenital NLD obstruction who had been treated in a university hospital with irrigation, probing, and intubation between 1998 and 2008 were reviewed. Clinical features were correlated to the documented intraoperative observations and postoperative results.

Patients with unilateral disease had a higher success rate (n = 10; 90%) than bilateral cases (n = 24; 45.8%) regardless of the procedure type. Most of the treated LDSs in patients older than 64 months were successful (n = 11 of 12; 91.7%). Single LDSs that underwent irrigation only (2.9%) failed, probing had 60% success (n = 10; 29.4%), and intubation had 60.9% success (n = 23; 67.7%). Four LDSs were treated successfully by Y-V plasty simultaneously with intubation. Lower-end NLD obstruction at the level of Hasner's valve showed a 100% success rate (n = 7) compared with multiple obstructions with a 41.7% success rate (n = 27).

Unilateral disease and lower-end NLD obstruction are good prognostic factors. Careful punctal evaluation and management is advisable, and a possible delay of operative intervention in bilateral cases in patients 5 years and older aimed at improving hypotonia may be a wise decision.