Congenital Anomalies of the Nasolacrimal Duct Treatment & Management

Updated: Mar 22, 2016
  • Author: Mounir Bashour, MD, PhD, CM, FRCSC, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
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Treatment

Medical Care

Congenital nasolacrimal duct obstructions spontaneously resolve in 90% of cases during the first year of life. Some physicians have advocated massage with digital pressure as an aid to speeding up this natural resolution. Other than massage, topical antibiotics are useful for mucopurulent discharge, but the only treatment of efficacy for those patients who do not resolve spontaneously is surgery.

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Surgical Care

Probing

Probing cures 95% of congenital nasolacrimal obstructions. Prognosis for probing decreases exponentially with the increasing number of probings and the age of the patient. Rarely, it is successful after the third time or after 3 years. [5]

Nasolacrimal intubation

It has been advocated as an alternate procedure to dacryocystorhinostomy (DCR) in children who have failed probing. [6]

Success rates of 80-95% have been reported, but most patients have only been probed twice or less and are younger than 2 years. Prognosis is poor for those patients with previous dacryocystitis and for those patients in which an obstruction is encountered during the procedure.

Lim et al noted that increasing the duration of intubation was not associated with increasing the chance of success but with a significantly higher risk of failure if longer than 18 months (P=0.03). [7] The retention of stents for longer than 12 months was associated with a significantly lower success rate (67%). The presence of Down syndrome, older age at the time of surgery, and gender of the patient were not predictive factors for treatment failure. The unplanned removal of the tubes because of dislodgement was the most common complication, occurring in 25% of eyes, but did not affect the functional outcome.

Balloon catheter dilatation of the nasolacrimal system with or without silicone tubing

This procedure has slightly better results than intubation alone. Most probing failures occur as a result of upper sac or mid duct obstructions and are not amenable to cure by instrumentation. Repeat probing procedures and intubation can cause serious complications, including false passages, canalicular scarring, and stenosis.

Dacryocystorhinostomy

This treatment is the criterion standard when a patent canalicular system is present. See Nasolacrimal Duct, Obstruction.

Conjunctival dacryocystorhinostomy

If the upper system is scarred or otherwise not amenable to opening, then it can be bypassed using a prosthesis, such as a Lester-Jones tube. This procedure probably should be avoided until the child is older than 10 years because the prosthesis does require care from the patient and often has minor complications and revisions. In punctal agenesis where no canalicular tissue can be identified, the insertion of a Lester-Jones tube is necessary.

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Consultations

Pediatrician, genetics counselor, or maxillofacial surgeon

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