title: Systematic, combined treatment approach to nasolacrimal duct obstruction in different age groups.
abstract: OBJECTIVE
  To report the outcome of a step-by-step treatment approach for congenital nasolacrimal duct obstruction (CNDO).
  
  
  METHODS
  Three-hundred and fifty eyes with CNDO were included in the study. A number of treatment methods were applied systematically until a successful outcome was achieved. Listed in order from simple to more complex, the following methods were used: conservative management (massage and topical antibiotics), high-pressure syringing, probing, and silicone intubation. Treatment efficacy was determined according to age (Group 1: 0-6 months, Group 2: 7-12 months, Group 3: 13-24 months, Group 4: 25-72 months) and success rates were compared.
  
  
  RESULTS
  Conservative management was applied only in children less than 1 year of age, and was successful in 91.8% of Group 1 and 60% of Group 2 eyes. The difference between these two success rates was significant (p = 0.003). High-pressure syringing was performed in children under 24 months of age, with success rates of 41.7% in Group 1, 33.3% in Group 2, and 12.5% in Group 3. The overall success rate for first probing in all groups was 76.1%, with a range of 69.4% to 80.9%. After second probing, the overall cure rate for the entire cohort was 88.0%, with a range of 74.9% to 94.8%. There was no real difference in probing cure rates relative to age (p > 0.05). Silicone intubation was indicated and performed in two eyes of Group 2 children, three eyes of Group 3, and nine eyes of Group 4. Two ducts in Group 4 eyes remained obstructed after silicone intubation.
  
  
  CONCLUSIONS
  The systematic treatment approach to CNDO, including conservative management and minimally invasive procedures such as high-pressure syringing, probing, and silicone intubation, is highly successful. In this study, the cure rate for this combined approach was 100% in youngsters under 2 years of age and 94.5% in children 2 to 6 years old.
authors.affiliation: Dept. of Ophthalmology, Gülhane Military Medical Academy, Haydarpaşa Teaching Hospital, Istanbul, Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Ciftçi
authors.forename: A
authors.initials: A
authors.lastname: Akman
authors.forename: M
authors.initials: M
authors.lastname: Sönmez
authors.forename: M
authors.initials: M
authors.lastname: Unal
authors.forename: A
authors.initials: A
authors.lastname: Güngör
authors.forename: V
authors.initials: V
authors.lastname: Yaylali
mesh_terms: D000375:Aging; D002648:Child; D002675:Child, Preschool; D003608:Dacryocystorhinostomy / Q000379:methods*; D006801:Humans; D007223:Infant; D007440:Intubation / Q000379:methods; D007767:Lacrimal Duct Obstruction / Q000151:congenital; D009301:Nasolacrimal Duct / Q000601:surgery*; D013594:Syringes; D016896:Treatment Outcome