title: Factors affecting treatment outcome in congenital nasolacrimal duct obstruction: A retrospective analysis from South India.
abstract: OBJECTIVE
  To investigate outcomes for different treatment modalities in congenital nasolacrimal duct obstruction (CNLDO) in an Indian population.
  
  
  METHODS
  Retrospective, interventional, case series.
  
  
  METHODS
  In an institutional setting, case records of patients with CNLDO from January 2008 to 2012, were reviewed, and data on patient demographics, clinical presentation, and treatment details (sac massage, probing, and/or dacryocystorhinostomy) were recorded. Success of treatment was defined as complete resolution of symptoms and negative regurgitation on pressure over lacrimal sac (ROPLAS) area.
  
  
  RESULTS
  Two hundred and ninety-eight eyes of 240 patients with a mean age of 22.2 ± 26.14 months (median = 12 months, interquartile range = 17) were analyzed. Sac massage (n = 226) was successful in 67 eyes (30%). Multivariable logistic regression analyses showed that children with mucoid ROPLAS were almost 6 times more likely (odds ratio [OR] = 5.55 vs. clear ROPLAS, 95% confidence interval [CI] = 2.35-13.09, P < 0.001) to experience failure of sac massage. Overall probing (n = 193) was successful for 143 (74%) eyes. Multivariable logistic regression showed that older children were 25% more likely to experience probing failure (OR = 1.25 for every 6 months increment in age, 95%, CI = 1.09-1.42, P = 0.001).
  
  
  CONCLUSIONS
  Sac massage is successful in only a third of our patients and those with mucoid ROPLAS are more likely to experience failure. Probing is successful in three-quarter of our subjects, and its success declines with a progressive increase in age. Lower socioeconomic status, poor general health, and recurrent respiratory infections are unique to our population and may influence outcomes.
authors.affiliation: General Ophthalmology, Aravind Eye Hospital, Puducherry, India.
authors.forename: Sahil
authors.initials: S
authors.lastname: Bhandari
authors.forename: Sabyasachi
authors.initials: S
authors.lastname: Sengupta
authors.forename: Dayakar
authors.initials: D
authors.lastname: Yadalla
authors.forename: Jayagayathri
authors.initials: J
authors.lastname: Rajagopalan
authors.forename: Girish Bharat
authors.initials: GB
authors.lastname: Velis
authors.forename: Deepti
authors.initials: D
authors.lastname: Talele
authors.forename: Sameer
authors.initials: S
authors.lastname: Kushwaha
mesh_terms: D001707:Biopsy, Needle; D002675:Child, Preschool; D003608:Dacryocystorhinostomy; D005260:Female; D006801:Humans; D007223:Infant; D007767:Lacrimal Duct Obstruction / Q000151:congenital / Q000628:therapy*; D008297:Male; D008405:Massage; D009301:Nasolacrimal Duct; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D016896:Treatment Outcome