Nasal endoscopy-guided primary nasolacrimal duct intubation for congenital nasolacrimal duct obstruction in children older than 4 years

PURPOSE

To evaluate the clinical outcomes of endoscopic guided primary bicanalicular intubation (BCI) for congenital nasolacrimal duct obstruction (CNLDO) in children older than 4 years.

METHODS

A total of 40 eyes from 33 children (18 males, 15 females) with CNLDO who underwent bicanalicular intubation were evaluated. The type of CNLDO was determined by endonasal endoscopic visualisation. The mean silicone tube removal time was 4.3 ± 0.9 months (ranging from 3 to 6 months). The children were followed up for 6 months after the removal of tubes. Therapeutic success was defined as the normal result of the fluorescein dye disappearance test and complete resolution of previous lacrimal symptoms and signs.

RESULTS

The median age was 80 [48] (range 48-156) months. Treatment success was achieved in 32 of 40 eyes (80.0%). A statistically significant correlation was observed between the age and success rate (p = 0.006). The success rate was lower in older children. Membranous type of CNLDO was observed in 47.5% (19/40) of the cases. The median age of patients with a membranous and complex type of CNLDO were 60 [30] months and 96 [53] months, respectively. Surgical success was 100% in the membranous type of CNLDO and 61.9% in the complex CNLDO group.

CONCLUSIONS

Primary BCI using nasal endoscopic visualisation has a favourably high success rate for treating CNLDO in children aged 4 to 13 years. Treatment success was found to be related to both the type of CNLDO and age.

Effectiveness of pediatric Crawford tube implants when endoscopically assisted by ENT surgeons

OBJECTIVE

Epiphora in pediatrics is commonly treated with silicone nasolacrimal stents. The most common treatment duration is 3 months, but tubes are often unintentionally removed earlier and are still effective. There is no consensus on how long tubes need to be in situ and what factors influence treatment success.

METHODS

A retrospective chart review of patients who underwent Crawford tube placement over a 10-year period (2009-2019) was conducted. Patients were age >18 years and had Crawford tubes placed in conjunction with an otolaryngologist, who performed nasal endoscopy for direct visualization when retrieving Crawford tubes and infracture of the inferior turbinate. Bicanalicular intubation was attempted in all cases; if not possible, monocanalicular intubation was performed.

RESULTS

Forty-two patients were included in this study, representing 50 eyes. Spontaneous extrusion of tubes occurred in 54% of eyes. Tubes remained in situ for an average of 17.1 weeks (0-113 weeks). Symptoms resolved in 86% of patients, similar to procedures without endoscopy. There were no intraoperative complications. There was no association between the rate of persistent symptoms and duration of treatment.

CONCLUSION

Nasolacrimal duct intubation using Crawford tubes performed under direct endoscopic visualization is consistently successful for the treatment of epiphora. Although epiphora can be self-resolving, persistent symptoms typically lasting past the first year of birth, warrant treatment. Children who receive Crawford tubes for epiphora commonly have spontaneous tube extrusion before treatment duration is complete. However, treatment success was not related to the length of time the tubes were in situ. Endoscopic visualization can help prevent intraoperative complications.

Systematic review of endoscopic-assisted surgical management for congenital nasolacrimal duct obstruction

OBJECTIVES

Epiphora is a common presenting complaint in infants affecting up to 6% of infants in the United States. It is most frequently due to congenital anomalies of the nasolacrimal duct system, termed congenital nasolacrimal duct obstruction (CNLDO). Nasolacrimal duct probing is widely accepted as the primary surgical intervention in cases that fail conservative management. Recently, nasal endoscopy has been combined with traditional probing to improve success rates and outcomes. Several studies have been conducted, but the results have been inconclusive overall. The goal of this systematic review is to examine the existing literature on the role of nasal endoscopy during nasolacrimal duct probing and evaluate patient outcomes.

METHODS

A systematic search was performed in PubMed, MEDLINE, The Cochrane Library, ClinicalTrials.gov, LILAC, and EMBASE to identify peer-reviewed research. Eligible studies were those containing original peer-reviewed research in English addressing nasolacrimal duct probing for congenital nasolacrimal duct obstruction in conjunction with nasal endoscopy. Two investigators independently reviewed all articles and extracted data. Bias was assessed using the Cochrane Collaboration's tool, the Newcastle-Ottawa Assessment scale, and the NIH Quality Assessment scale.

RESULTS

A literature review ultimately yielded 11 articles that were selected and included in our analysis. Of the seven case series, the success rate was 92.5% for a total of 492 eyes. Of the four cohort/case-control studies, the success rate in conventional probings was 75.3% for a total of 293 eyes. In probings with nasal endoscopy, the success rate was 95.3% for 162 eyes. Overall, there was a high risk of bias and variation in data reporting amongst studies.

CONCLUSION

Infants with congenital nasolacrimal duct obstruction that does not resolve with conservative treatment often require surgical intervention. Based on this systematic review of the current literature, nasal endoscopy is a useful adjunct for nasolacrimal duct probing.

Surgical management of congenital nasolacrimal duct obstruction; one procedure for all versus all procedures for one

PURPOSE OF REVIEW

After failed conservative management, most clinicians treat congenital nasolacrimal duct obstruction (CNLDO) in a conventional stepwise fashion: starting with probing, then repeat probing, next silicone intubation and/or balloon dilatation, and finally dacryocystorhinostomy. This approach is based on the patient's age and previously failed procedures and recruits 'one procedure for all' CNLDO. A newly introduced approach is based on the type of obstruction and recruits 'all procedures for one' CNLDO. The aim of this review is to examine the best available evidence regarding CNLDO management.

RECENT FINDINGS

Recent articles support the concept that through intraoperative evaluation of obstruction in CNLDO, clinicians may predict probing failure and instantaneously employ more appropriate treatment modalities. This review addresses whether an age-based approach should be changed into a one-stage obstruction-based approach.

SUMMARY

An age-based approach treats CNLDO as a homogeneous disease and thus treats all patients with one predetermined procedure. A one-stage obstruction-based approach, however, considers CNLDO to be a heterogeneous disease, and therefore allows recruitment of all procedures simultaneously and selects the best intraoperatively. It may allow replacement of the conventional stepwise approach to CNLDO treatment provided that randomized trials verify its efficacy, safety, and cost-effectiveness.Video abstract http://links.lww.com/COOP/A30.