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Published on: October 13, 2017
Resolution of congenital nasolacrimal duct obstruction with nonsurgical management
Insights
More than half of infant nasolacrimal duct obstruction (NLDO) cases resolve within six months of conservative treatment. This study shows nonsurgical management is effective for many infants with NLDO, aiding treatment decisions.
Area of Science:
- Ophthalmology
- Pediatrics
Background:
- Nasolacrimal duct obstruction (NLDO) is common in infants.
- Nonsurgical management, including massage and antibiotics, is often the first line of treatment.
Purpose of the Study:
- To determine the resolution rate of NLDO in infants aged 6 to <10 months treated nonsurgically for 6 months.
Main Methods:
- 107 infants aged 6 to <10 months with NLDO received 6 months of massage and topical antibiotics.
- Resolution was defined as the absence of clinical signs of NLDO and no surgery at 6 months.
- Exploratory analyses examined baseline characteristics associated with resolution.
Main Results:
- NLDO resolved without surgery in 66% of eyes (77/117) at 6 months.
- No baseline characteristics were associated with a higher probability of resolution.
- The 6-month examination was completed for 88% of eyes.
Conclusions:
- Over half of infants aged 6 to <10 months with NLDO experience resolution with 6 months of nonsurgical management.
- This data supports conservative management and informs discussions about treatment options for NLDO in infants.
Objective:
To determine how often nasolacrimal duct obstruction (NLDO) resolves with 6 months of nonsurgical management in infants aged 6 to less than 10 months.
Methods:
As part of a randomized trial evaluating the cost-effectiveness of immediate office probing vs observation with deferred probing for unresolved cases, 107 infants aged 6 to less than 10 months who had NLDO and no history of nasolacrimal duct surgery were prescribed 6 months of nasolacrimal duct massage and topical antibiotics as needed. Resolution of the NLDO was assessed 6 months after study entry and was defined as the absence of all clinical signs of NLDO (epiphora, increased tear lake, or mucous discharge) and not having undergone NLDO surgery. Exploratory analyses assessed whether baseline characteristics, including age, sex, laterality, and prior treatment, were associated with the probability of NLDO resolving without surgery.
Results:
At the 6-month examination, which was completed for 117 of the 133 eyes (88%), the NLDO had resolved without surgery in 77 eyes (66% [95% CI, 56%-74%]). None of the baseline characteristics we evaluated were found to be associated with resolution.
Conclusions:
In infants 6 to less than 10 months of age, more than half of eyes with NLDO will resolve within 6 months with nonsurgical management. Knowledge of the rate of NLDO resolution in infancy without surgery will help clinicians and parents effectively discuss treatment options.
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