title: The course of epiphora after failure of silicone intubation for congenital nasolacrimal duct obstruction.
abstract: BACKGROUND
  One of the indications for dacryocystorhinostomy (DCR) in children with congenital nasolacrimal duct obstruction (CNLDO) is failure of silicone intubation. We evaluated the course of epiphora after failure of silicone intubation for CNLDO when DCR was not performed.
  
  
  METHODS
  In a comparative cohort study carried out at a tertiary referral center, ten eyes of seven consecutive children who had failure of silicone intubation manifested as persistent epiphora over 2 months and whose parents refused DCR were followed up for an average of 50.4 months (range 33-70 months). Three lacrimal drainage systems of three other children who had failure of silicone intubation underwent uneventful DCR.
  
  
  RESULTS
  In eight (80%) of the ten consecutive eyes with congenital nasolacrimal duct obstruction (six of the seven children, 86%), there was spontaneous complete resolution of the epiphora and normal dye disappearance test (DDT) at the end of the follow-up period. One child with Down's syndrome, allergic rhinitis, asthma and multiple site obstructions had improvement of symptoms but abnormal DDT. The epiphora in all three children who underwent DCR had disappeared by 6 months after surgery when the silicone tube was removed. No complications were noted during the follow-up.
  
  
  CONCLUSIONS
  Epiphora can spontaneously resolve after failure of silicone intubation in CNLDO, and DCR should no longer considered be compulsory in such cases unless complications evolve.
authors.affiliation: Department of Ophthalmology, Western Galilee-Nahariya Medical Center, P.O. Box 21, 22100 Nahariya, Israel.
authors.forename: Yanir
authors.initials: Y
authors.lastname: Kassif
authors.forename: Uri
authors.initials: U
authors.lastname: Rehany
authors.forename: Michal
authors.initials: M
authors.lastname: David
authors.forename: Anna
authors.initials: A
authors.lastname: Popko
authors.forename: Shimon
authors.initials: S
authors.lastname: Rumelt
mesh_terms: D002675:Child, Preschool; D003608:Dacryocystorhinostomy; D005260:Female; D006801:Humans; D007223:Infant; D007440:Intubation; D007766:Lacrimal Apparatus Diseases / Q000503:physiopathology*; D007767:Lacrimal Duct Obstruction / Q000151:congenital / Q000503:physiopathology*; D008297:Male; D009301:Nasolacrimal Duct / Q000503:physiopathology*; D012826:Silicone Elastomers
chemical_list: D012826:Silicone Elastomers