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Updated: May 16, 2026
Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction
Published on: October 13, 2017
A randomized trial comparing the cost-effectiveness of 2 approaches for treating unilateral nasolacrimal duct
Insights
Immediate office probing for infant nasolacrimal duct obstruction (NLDO) is more cost-effective and leads to quicker symptom resolution than observation. This approach offers a potentially cost-saving treatment option for this common condition.
Area of Science:
- Ophthalmology
- Pediatric Otolaryngology
Background:
- Unilateral nasolacrimal duct obstruction (NLDO) is a common condition in infants.
- Treatment strategies vary, with options including observation, nonsurgical management, and surgical probing.
Purpose of the Study:
- To compare the cost-effectiveness of immediate office-based nasolacrimal duct probing versus a strategy of observation followed by deferred probing for unilateral NLDO in infants.
- To evaluate treatment success rates and symptom duration for both approaches.
Main Methods:
- A randomized controlled trial involving 163 infants aged 6 to <10 months with unilateral NLDO.
- Infants were assigned to immediate office probing (n=82) or 6 months of observation/nonsurgical management followed by facility probing if symptoms persisted (n=81).
- Treatment success was defined as the absence of NLDO signs at 18 months; costs included all procedures and medications.
Main Results:
- Immediate office probing resulted in a 92% success rate compared to 82% for the observation group.
- The immediate probing group had a mean cost of $562 versus $701 for the observation group, representing a cost saving of $139.
- Infants in the immediate probing group experienced 3.0 fewer months of symptoms.
Conclusions:
- Immediate office probing is a more cost-effective and efficient treatment for unilateral NLDO in infants.
- This approach leads to higher success rates and faster symptom resolution.
- Immediate office probing avoids the need for general anesthesia in many cases, even if some infants would have resolved spontaneously.
Objective:
To compare the cost-effectiveness of 2 approaches for treating unilateral nasolacrimal duct obstruction (NLDO).
Methods:
One hundred sixty-three infants aged 6 to less than 10 months with unilateral NLDO were randomly assigned to receive immediate office-based nasolacrimal duct probing (n = 82) or 6 months of observation/nonsurgical management (n = 81) followed by probing in a facility for persistent symptoms.
Main Outcome Measures:
Treatment success was defined as the absence of clinical signs of NLDO (epiphora, increased tear lake, mucous discharge) on masked examination at age 18 months. Cost of treatment between randomization and age 18 months included costs for all surgical procedures and medications.
Results:
In the observation/deferred facility-probing group, NLDO resolved within 6 months without surgery in 44 of the 67 patients (66%; 95% CI, 54% to 76%) who completed the 6-month visit. Twenty-two (27%) of the 81 patients in the observation/deferred facility-probing group underwent surgery, 4 of whom were operated on within the initial 6 months. At age 18 months, 69 of 75 patients (92%) in the immediate office-probing group were treatment successes, compared with 58 of 71 observation/deferred facility-probing group patients (82%) (10% difference in success; 95% CI, -1% to 21%). The mean cost of treatment was $562 in the immediate office-probing group compared with $701 in the observation/deferred facility-probing group (difference, -$139; 95% CI, -$377 to $94). The immediate office-probing group experienced 3.0 fewer months of symptoms (95% CI, -1.8 to -4.0).
Conclusions:
The immediate office-probing approach is likely more cost-effective than observation followed by deferred facility probing if needed. Adoption of the immediate office-probing approach would result in probing in approximately two-thirds of infants whose obstruction would have resolved within 6 months of nonsurgical management, but would largely avoid the need for probing under general anesthesia.
Application To Clinical Practice:
Although unilateral NLDO often resolves without surgery, immediate office probing is an effective and potentially cost-saving treatment option.
Trial Registration:
clinicaltrials.gov Identifier: NCT00780741.
