Multidisciplinary Management of Paediatric Nasolacrimal Duct Obstruction at a Tertiary Hospital: A Five-Year Review

Introduction Nasolacrimal duct obstruction (NLDO) is the most common cause of childhood epiphora. Congenital NLDO is usually managed conservatively in the first year of life; failing which, surgical interventions - such as syringing and probing (S&P), insertion of stents (intubation), or dacryocystorhinostomy (DCR) - are offered in a stepwise manner. The aim of this study was to evaluate the outcomes of our joint ophthalmology-ENT service in the management of NLDO. Methods This was a retrospective study conducted at a tertiary paediatric hospital. Nasolacrimal surgeries were retrieved from Hospital Episode Statistics (HES) data for a five-year period between May 2017 and April 2022. A retrospective case-note review was undertaken to examine demographics, presentation, surgical interventions, and outcomes (classified as complete resolution, partial improvement, or no improvement). Results At our institution, NLDO surgeries are performed on a joint ophthalmology/ENT list. A total of 301 procedures were performed on 218 patients (293 eyes). The causes of epiphora included congenital NLDO (n = 193, 88.5%), secondary NLDO (n = 10, 4.6%), and dacryocystitis/mucocele (n = 8, 3.7%), among others. The median age at the first procedure was 26 months (range: 2-189). The median number of procedures for congenital NLDO was one (range: 1-5). The success rates were 73% for all S&P procedures (n = 135/185), 78% for intubation (n = 76/98), and 58% for DCR (n = 10/17). Patients with craniofacial syndromes required a statistically significantly higher number of DCRs. Overall, epiphora was completely resolved in 81% of cases (n = 237), partially resolved in 6% (n = 18), and was persistent in 13% (n = 38). Conclusion A multidisciplinary approach to NLDO ensures the efficient delivery of care by minimising the number of procedures and hospital attendances. Congenital NLDO can be successfully treated in the vast majority of cases with S&P and intubation. In cases with bony anatomical abnormalities, there should be a low threshold for considering DCR.