The authors evaluated changes in management of congenital nasolacrimal duct obstruction (CNLDO) by surveying 1495 Association for Paediatric Ophthalmology & Strabismus (AAPOS) members. The survey consisted of 21 multiple choice questions with anonymised return. Responses were received from 127 members and six were excluded as potentially biased. A total of 84% were completed by North American members and 16% by international members which was reflective of the AAPOS organisational membership. Ninety-five percent regularly treat CNLDO. For treatment in the first year of life 45% perform the Crigler manoeuvre on the initial visit for infants younger than six months. Of these 82% instruct carers to massage the duct and 17% offer office probing but this is significantly more for those with >10 years’ experience. Surgical treatment includes 79% recommending surgery from 13 months of age for unresolved cases, and 12% for infants aged 10-12 months. Seventy-nine percent chose probing as their primary treatment. In children with first surgery at age two years, 53% chose non-probing procedures. For children aged three years at first procedure, 67% chose non-probing procedures. For failed probing, most opted for silicone intubation with or without balloon dacryoplasty. With silicone intubation, 64% preferred monocanalicular tubes typically left in place for three to four months. For bicanalicular tubes, most were removed in the office and the remainder in the operating room. With regard to risk of amblyopia, 91% regularly check refraction at the initial visit and 45% recheck when aged one to two years. This study found a striking lack of consensus among ophthalmologists. 

Congenital nasolacrimal duct obstruction: common management policies among pediatric ophthalmologists.
Dotan G, Nelson LB.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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