Endoscopic dacryocystorhinostomy in children.
BACKGROUND
Persistent nasolacrimal duct obstruction (NLDO) often requires treatment by probing, intubation, or balloon dacryoplasty. Refractory cases have been managed by external dacryocystorhinostomy (DCR), which leaves a scar; however, this procedure is generally avoided in young children. Endoscopic DCR has been successfully performed in adults and described in children. We report the success of this procedure in a series of pediatric patients.


METHODS
A retrospective review of all endoscopic lacrimal procedures performed in a 3-year period was undertaken. Seventeen children (22 ducts) with persistent NLDO after at least one failed probing, with or without silicone tube placement, underwent endoscopic DCR. Follow-up ranged from 6 to 36 months, and success was defined as resolution of tearing and discharge by follow-up clinical evaluation and by parental history.


RESULTS
All but 2 patients (88%) with NLDO showed complete resolution of tearing and discharge. These 2 patients had recurrent symptoms after the Crawford tubes were removed and required revision endoscopic DCR. No complications from this procedure were noted.


CONCLUSIONS
Endoscopic DCR is a safe and effective means of treating persistent NLDO in infants and young children when simple probing, intubation, or balloon procedures have failed. The team ophthalmology-otolaryngology endoscopic approach provides a highly successful alternative for patients with a persistent distal obstruction that might otherwise require an external procedure.
Vanderveen
D K
DK
Department of Ophthalmology, Children's Hospital, Boston, Massachusetts, USA. deborah.vanderveen@tch.harvard.edu
Jones
D T
DT
Tan
H
H
Petersen
R A
RA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003608:Dacryocystorhinostomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007767:Lacrimal Duct Obstruction / Q000503:physiopathology; D008297:Male; D009301:Nasolacrimal Duct / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012449:Safety; D016896:Treatment Outcome