The most common treatment for congenital lacrimal duct obstruction (CLDO) is probing, which is traditionally a blind procedure. Previous literature reports success rates between 78-92%. The authors of this retrospective non comparative case series reviewed the success rates of probing with dacryoendoscopy, which enables simultaneous probing with visualisation of the site of obstruction. Ten patients (13 lacrimal ducts) over the age of one year (mean age 40.7 months, range 14-74 months) diagnosed with CLDO who underwent direct endoscopic probing with dacryoendoscopy under general anaesthesia were included in this study. The dacryoendoscope was inserted into the lacrimal drainage system via the punctum. Once the site of obstruction was seen, the endoscope was advanced to perforate the obstructed area. Telephone interviews were performed six months after the surgery to assess the subjective outcome of the procedure. Disappearance of epiphora was reported in 12/13 (92.3%) cases. However, 5/13 (38.5%) reported occasional discharge from the eye. Two of the 13 cases had undergone previous unsuccessful blind probing, one of these two cases had subsequent successful direct endoscopic probing, the other had persistent epiphora. Various sites of obstruction were noted; the most common were the nasolacrimal duct (7/13), Valve of Hasner (2/13), lacrimal sac (2/13) and the canaliculus (2/13). Two of the 13 cases had more than one site of obstruction. No obstruction was seen in one patient but a hypertrophic mucous membrane was noticed and probing had resulted in disappearance of epiphora. There were no complications from intraoperative endoscopy or general anaesthesia. The authors conclude that probing with dacryoendoscopy is a safe and effective treatment method for CLDO but are aware that their conclusions are limited by the small number of cases studied.

Direct endoscopic probing for congenital lacrimal duct obstruction.
Sasaki H, Takano T, Murakami A.
2013 Nov;41(8):729-34


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Anjali Gupta

Birmingham and Midland Eye Centre, Birmingham, UK.

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