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Initial management of congenital canalicular atresia
Mohamed Soliman1, Gregg T Lueder1
1Departments of Ophthalmology and Visual Sciences and Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri.
Insights
Nasolacrimal duct obstruction management in children with canalicular atresia (CA) shows success with probing through the patent canaliculus for upper CA. Lower CA may require additional interventions like balloon catheter dilation or stenting for optimal outcomes.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Anatomy
Background:
- Lacrimal canalicular atresia (CA) is a congenital condition causing nasolacrimal duct (NLD) obstruction in pediatric patients.
- Initial management strategies aim to restore tear drainage and alleviate symptoms.
Purpose of the Study:
- To evaluate the effectiveness of initial surgical management for pediatric patients presenting with canalicular atresia (CA) affecting the upper or lower eyelid.
- To compare outcomes of NLD probing through the patent canaliculus for upper versus lower CA.
Main Methods:
- Retrospective review of 15 pediatric patients with NLD obstruction and CA from 1994 to 2014.
- Surgical intervention involved NLD probing through the patent canaliculus.
- Outcomes were categorized as good, fair, or poor based on symptom resolution and need for further surgery.
Main Results:
- Canalicular atresia (CA) was identified in 19 eyes (11 upper, 8 lower).
- NLD probing through the lower canaliculus yielded good outcomes in all 11 eyes with upper CA.
- NLD probing through the upper canaliculus resulted in good outcomes for 50% of eyes with lower CA; the remaining 50% required additional treatments (balloon catheter dilation, monocanalicular stent) for improvement.
Conclusions:
- NLD probing via the patent lower canaliculus is a successful initial treatment for upper CA.
- Lower CA management via the upper canaliculus has a lower success rate, suggesting the need for adjunctive procedures.
- Consideration of balloon catheter dilation or monocanalicular stent placement during initial surgery for lower CA is recommended.
Purpose:
To evaluate the initial management of pediatric patients with lacrimal canalicular atresia (CA) involving the upper or lower eyelid.
Methods:
The medical records of 15 children with symptoms of nasolacrimal duct (NLD) obstruction and CA of either the upper or lower eyelid treated from 1994 to 2014 were retrospectively reviewed. Surgical treatment consisted of nasolacrimal probing through the patent canaliculus. Preoperative findings, treatment, and outcomes were reviewed. Outcomes were considered good if the patients had resolution of signs and symptoms of lacrimal obstruction, fair if the symptoms improved and additional surgery was not required, and poor if additional lacrimal surgery was performed.
Results:
CA was found in 19 eyes of 15 patients: 11 eyes had upper CA; 8 eyes, lower. All 11 eyes with upper CA improved after NLD probing through the patent lower canaliculus. Of the 8 eyes with lower CA, 4 (50%) had good outcomes and 4 eyes had poor outcomes after NLD probing through the patent upper canaliculus. All of the latter patients improved after subsequent treatment with balloon catheter dilation (BCD), monocanalicular stent placement, or both.
Conclusions:
If a patient is found to have upper CA during initial surgery for NLD obstruction, NLD probing through the patent lower canaliculus has a good rate of surgical success. For patients with lower CA, the success rate of NLD probing through the upper canaliculus appears to be lower. Additional treatment during the initial surgery with either BCD or monocanalicular stent placement should be considered in these patients.
