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Published on: October 13, 2017
A comparison of treatment approaches for bilateral congenital nasolacrimal duct obstruction
Katherine A Lee1, Danielle L Chandler, Michael X Repka
1St. Luke's Children's Ophthalmology, Boise, Idaho.
Insights
Immediate office probing and deferred probing are both effective treatments for infant bilateral nasolacrimal duct obstruction (NLDO). Both approaches offer successful outcomes for infants with this common condition.
Area of Science:
- Ophthalmology
- Pediatric Medicine
Background:
- Infantile bilateral nasolacrimal duct obstruction (NLDO) is a common condition.
- Timely intervention is crucial for managing NLDO and preventing complications.
Purpose of the Study:
- To compare the clinical outcomes of immediate office-based probing versus a strategy of observation and delayed surgical facility-based probing for bilateral nasolacrimal duct obstruction in infants.
- To evaluate the efficacy and success rates of two distinct treatment pathways for infantile NLDO.
Main Methods:
- A multicenter, randomized clinical trial involving 57 infants (6-10 months) with bilateral NLDO.
- Participants were randomized to either immediate office probing or 6 months of observation followed by facility-based probing if necessary.
- Treatment success was defined by the absence of NLDO signs at 18 months of age via masked examination.
Main Results:
- The immediate office probing group achieved success in both eyes for 66% of participants.
- The observation and deferred facility probing group achieved success in both eyes for 76% of participants.
- No statistically significant difference in overall treatment success was observed between the two groups (difference = -10%; 95% CI = -35% to 14%).
Conclusions:
- Both immediate office probing and observation with deferred facility probing are successful and reasonable treatment options for infants with bilateral NLDO.
- The choice of treatment approach may depend on clinical judgment and patient-specific factors.
Purpose:
To compare the clinical outcomes of two treatment approaches for bilateral nasolacrimal duct obstruction (NLDO) in infancy.
Design:
Multicenter, randomized clinical trial.
Methods:
We studied 57 infants between the ages of 6 and <10 months who had bilateral NLDO. Participants were randomized to receive either (1) immediate office-based probing within two weeks (n = 31) or (2) 6 months of observation and nonsurgical management followed by surgical facility-based probing for unresolved cases (n = 26). Treatment success was defined as the absence of clinical signs of NLDO (epiphora, increased tear lake, mucous discharge) in both eyes on masked examination at 18 months of age.
Results:
In the observation and deferred facility probing group, resolution without surgery occurred by 6 months after randomization in both eyes for 14 participants (56%), in one eye for 5 (20%), and in neither eye for 6 (24%). Eight participants in the observation and deferred facility probing group underwent facility probing (one of whom later had a second facility probing). Four participants in the immediate office probing group later underwent an additional procedure in a surgical facility. In the immediate office probing group, treatment success at 18 months of age occurred in both eyes for 19 of 29 (66%) participants and in one eye for 3 (10%); in the observation and deferred facility probing group, treatment success occurred in both eyes for 19 of 25 (76%) participants and in one eye for 3 (12%) (difference in success = -10%; 95% CI = -35% to 14%).
Conclusions:
Both the immediate office probing approach and the observation and deferred facility probing approach are successful and reasonable treatment options for infants with bilateral NLDO.
