Success of nasolacrimal probing not affected by age or surgeon experience

In a recent retrospective review of nasolacrimal duct probing under general anesthesia by Joao Beato and colleagues, in the Journal of Pediatric Ophthalmology and Strabismus, it was reported that the success rate was not related to age, gender, laterality or the surgeon’s experience for a patient up to 4 years old. The study also recommended probing alone until 4 years old, as the success rate was 77% on first probing and up to 90% on second probing. It has traditionally been felt that after 3 years of age the success rate decreases, and it is preferable to perform prior to this time. It is welcome news that obtaining good results for patients 4 years of age and older is possible in instances where it could not be done sooner. However, it does not address other issues. If probing is done in the office by 9 months of age then the success rate is as high. Also, avoiding general anesthesia is worthwhile particularly with recent data of repeated anesthesia issues on infants (I admit usually longer anesthesia procedures). Second, the addition of nasolacrimal intubation when a patient is under general anesthesia will decrease the failure rate and will decrease the need for a second anesthesia, particularly the older a child is. Those issues should be taken into account when deciding best time for correction of congenital nasolacrimal duct obstruction.