Endoluminal lacrimal duct recanalization for pediatric lacrimal duct obstruction: etiologic spectrum and surgical outcomes.

Abstract

Purpose: To clarify the clinical characteristics and etiologic diversity of pediatric lacrimal duct obstruction in children aged ≥1 year requiring surgical treatment under general anesthesia and to evaluate the outcomes of endoluminal lacrimal duct recanalization (ELDR).

Study design: Retrospective observational study.

Methods: All pediatric lacrimal surgical procedures performed under general anesthesia at our institution between 2011 and July 2025 were reviewed. All cases underwent dacryoendoscopic evaluation and treatment. Clinical characteristics, etiologies, and surgical outcomes were analyzed.

Results: The study included 245 patients (338 eyes). Thirty-four eyes (10.1%) had a history of failed probing. Congenital obstruction accounted for 259 eyes (76.6%), acquired obstruction for 38 eyes (11.2%), and syndromic cases for 41 eyes (12.1%). Approximately one-third of all eyes had simple congenital nasolacrimal duct obstruction (CNLDO) caused by membranous distal obstruction. Post-epidemic keratoconjunctivitis obstruction accounted for approximately 10% of cases, for which favorable outcomes were demonstrated following ELDR with intubation. In nonsyndromic cases (congenital and acquired), the success rate, defined as complete resolution, was 97.6% (290/297 eyes). In contrast, syndromic cases demonstrated a significantly lower success rate of 56.1% (23/41 eyes; P < 0.001). No major complications were observed.

Conclusions: The obstruction of the lacrimal duct in pediatric patients requiring surgery under general anesthesia includes a broad spectrum of pathologies beyond simple CNLDO. In patients without congenital malformation syndromes, ELDR was associated with a high success rate and appears to be a safe and effective treatment option for pediatric lacrimal duct obstruction.