Risk Factors for Poor Surgical Outcome of Pediatric Nasolacrimal Duct Obstruction

To determine whether there are common factors that may help predict if a child is at a higher risk for surgical failure for nasolacrimal duct obstruction.

This retrospective, observational case-control clinical study reviewed patient factors present prior to surgical intervention and their correlation with the necessity of multiple surgeries. A pediatric ophthalmologist identified patients who required surgical correction based on symptom history refractory to conservative management. Patients were grouped by the need for multiple surgical interventions versus single surgery. Patient factors hypothesized to predispose patients to an unsuccessful initial procedure were compared via odds ratio analysis. Patient success was based on symptom resolution 6 months postoperatively.

Patient factors with statistically significant increased odds ratios were trisomy 21, allergic rhinitis/seasonal allergies, history of an upper respiratory tract infection within 1 month, and obstructive sleep apnea.

This study suggests that patients with trisomy 21 or a history of recent upper respiratory tract infection may be correlated with a higher risk of failure with a probing and irrigation surgery only. Patients with trisomy 21 may benefit from an initial balloon dilation procedure rather than probing and irrigation, due to an increased risk profile. Patients with a recent upper respiratory tract infection may benefit from postponing surgery until symptom treatment or resolution. [J Pediatr Ophthalmol Strabismus. 2019;56(4):261-264.].