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Published on: October 13, 2017
Clinical Outcome of Probing in Infants with Acute Dacryocystitis - A Prospective Study
Bhawesh Chandra Saha1, Rashmi Kumari2, Bibhuti Prasanna Sinha3
1Senior Resident, Department of Ophthalmology, AIIMS, Patna, Bihar, India.
Insights
Simultaneous probing of the nasolacrimal duct (NLD) alongside medical management shows a good success rate for infantile acute dacryocystitis. However, complications like dacryopyocele may reduce probing effectiveness.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Infantile acute dacryocystitis is a serious condition requiring prompt treatment.
- While systemic antibiotics are standard, simultaneous nasolacrimal duct (NLD) probing is increasingly supported.
Purpose of the Study:
- To evaluate the success rate of NLD probing in infantile acute dacryocystitis.
- To identify factors influencing the success of this intervention.
Main Methods:
- A prospective study enrolled infants with acute dacryocystitis from May 2014 to April 2016.
- Patients received intravenous antibiotics and underwent NLD probing under general anesthesia.
- Success was defined as symptom resolution at one-month follow-up.
Main Results:
- The study included 20 eyes from 18 infants (mean age 6.5 months).
- 85% of eyes achieved complete symptom resolution after one month.
- 15% experienced recurrence of epiphora after initial improvement.
Conclusions:
- Combined medical management and NLD probing offer a good success rate for infantile dacryocystitis.
- Dacryopyocele or dacryocystocele may impede probing success due to intranasal cysts.
Introduction:
Acute dacryocystitis is an uncommon but serious condition in infants and needs immediate treatment. Although, medical management with systemic antibiotics remains the mainstay of initial treatment, there are recent studies justifying simultaneous Naso Lacrimal Duct (NLD) probing with acceptable success rate.
Aim:
To assess the success rate of probing in the management of infantile acute dacryocystitis and to analyse the factors affecting it.
Materials And Methods:
A prospective interventional study was designed and infants presenting with acute dacryocystitis with or without complications like dacryocystopyocele/ lacrimal abscess/preseptal cellulitis at a Tertiary Eye Care Centre from May 2014 to April 2016 were enrolled. Demographic details and baseline clinical characteristics were noted. Intravenous antibiotics were started and probing under general anaesthesia was done. Follow up was done after one month. Success was defined as subsidence of acute attack and resolution of epiphora at final follow up of one month.
Results:
A total 20 eyes of 18 patients were included with male: female ratio 10:8. Mean age of patients was 6.5 months and the mean duration of symptoms was 5.6 days. Dacryocystitis with lacrimal swelling was present in five eyes, preseptal cellulitis was present in two eyes while the rest 13 eyes presented with simple inflammation over the lacrimal sac. After one month, 85% (17eyes) had complete resolution of symptoms. Recurrence of epiphora was seen in 15% (three eyes) after initial improvement.
Conclusion:
Medical management with simultaneous probing of nasolacrimal duct has fairly good success rate in infantile dacryocystitis. Presence of dacryopyocele or dacryocystocele can lead to failure of probing owing to presence of intranasal cysts.
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