[Outcome of Congenital Obstruction of the Nasolacrimal Duct].

Abstract

Background: Congenital nasolacrimal duct obstruction, a common condition in newborns, is characterised by narrowing of the tear drainage system, often at the nasolacrimal duct. In most cases, the tear duct opens spontaneously within the first year of life, assisted by massage. In cases where there is no improvement, surgical probing may be required. This study aimed to analyse the presentation and outcomes of surgically treated tear duct obstructions in children at our clinic.

Patients and methods: A retrospective analysis was conducted using electronic medical records of patients under 18 years of age who were treated for congenital nasolacrimal duct obstruction between 2011 and 2023. Data collected included demographic information, symptoms, stenosis location, surgical therapy, and outcomes. Additionally, parents of the patients were surveyed regarding the postoperative condition and symptomatology. The study was approved by the Cantonal Ethics Commission Zurich (BASEC2022-00830).

Results: Of a total of 147 identified patients (39 female, 62 male), 69% could be analysed with available consent. The age at initial examination ranged from 8 months to 12 years (median 27 months). Unilateral stenosis was observed in 69% of cases and bilateral stenosis in 31%. The most common symptoms were epiphora (95%), matted eyelashes (68%), mucous discharge (23%), and redness of the eyelids/conjunctiva (19%). Malformations were identified intraoperatively in 11% of cases. A second probing was necessary in 10% of cases, with ages ranging from 18 to 69 months (median 38 months). Dacryocystorhinostomy was performed in 4% of cases (age 92 - 145 months, median 113 months). Postoperatively, 70.5% reported subjective and/or objective symptom resolution, 22.7% experienced persistent epiphora, and 6.8% had recurrent matted eyelashes. Of the 101 patients surveyed, 77 responded to the questionnaire. Among them, 92% reported that tearing was no longer present, 96% no longer required therapy, 97% reported uncomplicated surgery, 17% experienced recurrent tearing, and 6% required additional non-lacrimal treatments.

Conclusion: In most cases, probing and irrigation alone are sufficient for healing. Temporary stent placement is more frequently necessary in older children. An intervention after 18 months of age does not negatively impact healing.