Endoscopic and surgical evaluation of epiphora in children with Down syndrome

Area of Science:

• Ophthalmology
• Genetics
• Pediatric Surgery

Background:

• Down syndrome (DS) is associated with various congenital anomalies, including potential issues within the nasolacrimal drainage system.
• Primary epiphora, or excessive tearing, can significantly impact the quality of life for affected individuals, particularly children.

Purpose of the Study:

• To investigate the clinical features and surgical results for primary epiphora in patients with Down syndrome.
• To analyze the effectiveness of different surgical interventions for epiphora in this specific population.

Main Methods:

• Retrospective review of medical records for 63 children with Down syndrome and primary epiphora treated at a tertiary pediatric hospital (2013-2023).
• Analysis included clinical characteristics, diagnostic findings (lacrimal syringing, dacryoendoscopy), and surgical outcomes (probing, endoluminal lacrimal duct recanalization with stent intubation).

Main Results:

• Epiphora was congenital in 67% of patients; 70% had passage on lacrimal syringing, while 30% showed obstruction.
• Eighteen patients underwent surgery, with complete resolution in 7 (39%), partial resolution in 10 (56%), and failure in 1 (5%).
• Dacryoendoscopy identified dense fibrous tissue, suggesting chronic inflammation, as a cause of obstruction in several cases.

Conclusions:

• Dacryoendoscopy revealed stenotic lacrimal passages due to developmental anomalies and chronic inflammatory fibrous obstruction in DS patients with epiphora.
• Surgical interventions (probing or ELDR) yielded only partial symptom improvement in approximately two-thirds of patients, indicating limited efficacy for complete resolution.