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Paediatric dacryocystorhinostomy
K N Hakin1, T J Sullivan, A Sharma
1Moorfields Eye Hospital, London, United Kingdom.
Insights
Dacryocystorhinostomy surgery in children is safe and effective for resolving congenital nasolacrimal duct obstruction. Success rates are highest when there is no associated canalicular disease.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Congenital nasolacrimal duct obstruction is a common condition in children.
- Surgical intervention, such as dacryocystorhinostomy (DCR), is often necessary for persistent cases.
- Canalicular involvement can complicate DCR outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of dacryocystorhinostomy in pediatric patients.
- To assess the impact of canalicular pathology on DCR success rates.
- To determine the optimal surgical approach for different types of nasolacrimal duct obstruction.
Main Methods:
- Retrospective review of 258 pediatric DCR cases from 1981-1991.
- Categorization of cases based on obstruction type: simple congenital, punctal agenesis, lacrimal fistula, post-traumatic, and post-inflammatory.
- Analysis of surgical outcomes with and without canalicular intubation or Lester-Jones tube placement.
Main Results:
- 96% of children (171/177) without canalicular pathology were successfully treated with a single DCR operation.
- DCR with canalicular intubation achieved substantial improvement in 79% of cases (55/70) with canalicular disease.
- DCR with Lester-Jones tube showed improvement in 10 of 11 cases with canalicular disease.
- No perioperative or postoperative blood transfusions were required.
Conclusions:
- Dacryocystorhinostomy is a safe and highly effective surgical procedure for pediatric nasolacrimal duct obstruction.
- Outcomes are significantly better in the absence of canalicular pathology.
- Experienced surgical technique is crucial for achieving optimal results in children.
Abstract:
Of 258 cases of dacryocystorhinostomy performed on children in the period September 1981 to September 1991, 130 were for simple, unresolved congenital nasolacrimal duct obstruction. Other indications for surgery included punctal agenesis, lacrimal fistula, post-traumatic and post-inflammatory canalicular obstruction. Of 177 children without canalicular pathology, 171 (96%) were relieved of symptoms with one operation, without canalicular intubation. Of 81 cases with canalicular disease, 55 of 70 (79%) who underwent DCR plus canalicular intubation, and 10 of 11 who underwent DCR plus Lester-Jones tube, were substantially improved with one operation. No child required peroperative or postoperative blood transfusion. Dacryocystorhinostomy in childhood, in experienced surgical hands, is a safe procedure, achieving relief of symptoms in most cases, particularly in the absence of canalicular disease.