title: Pediatric endoscopic dacryocystorhinostomy failures: who and why?
abstract: OBJECTIVE
  The objectives of this study are to report outcomes of pediatric patients with nasolacrimal duct obstruction (NLDO) who underwent primary endoscopic dacryocystorhinostomy (DCR) and discuss causes of failure.
  
  
  METHODS
  The authors conducted a retrospective case series.
  
  
  METHODS
  Charts of all patients less than 16 years of age who underwent primary endoscopic DCR from 1997 to 2004 were reviewed. Patients were grouped based on the presence or absence of facial anomalies or syndromes and whether the NLDO was congenital or acquired. Success was defined as complete resolution of symptoms, improvement included anatomic patency or partial symptoms, and failure as no improvement or demonstration of patency.
  
  
  RESULTS
  Thirty-four patients (43 ducts) aged 11 months to 14 years were identified. There were 17 males and 17 females. Follow up ranged from 2 to 54 months (average, 21 months). Twenty-four patients (29 ducts) had congenital NLDO, seven patients (11 ducts) had congenital syndromes associated with craniofacial abnormalities, and three patients (three ducts) had acquired NLDO. In patients with congenital NLDO without craniofacial abnormalities or syndromes, 22 of 29 eyes (76%) were cured with another three (10%) showing improvement. Only one of 11 (9%) eyes of patients with congenital craniofacial abnormality or syndrome experienced complete resolution and only four of 11 (36%) eyes showed improvement. Of the patients with acquired NLDO, two of three (67%) of the eyes were cured and one (33%) improved.
  
  
  CONCLUSIONS
  Endoscopic DCR is safe and effective for most children, although patients with craniofacial abnormalities or syndromes are extremely difficult to cure.
authors.affiliation: Department of Otolaryngology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Dwight T
authors.initials: DT
authors.lastname: Jones
authors.forename: Norman F
authors.initials: NF
authors.lastname: Fajardo
authors.forename: Robert A
authors.initials: RA
authors.lastname: Petersen
authors.forename: Deborah K
authors.initials: DK
authors.lastname: VanderVeen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019465:Craniofacial Abnormalities / Q000150:complications; D003608:Dacryocystorhinostomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007767:Lacrimal Duct Obstruction / Q000151:congenital; D008297:Male; D012189:Retrospective Studies; D013577:Syndrome; D017211:Treatment Failure; D016896:Treatment Outcome