Endoscopic dacryocystorhinostomy effective for pediatric congenital nasolacrimal canal dysplasia
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In children with congenital nasolacrimal canal dysplasia, the combination of endoscopic dacryocystorhinostomy and lacrimal CT scan may be advantageous over traditional solutions, according to retrospective study.
All 50 eyes of 49 children aged 2 to 14 years with congenital nasolacrimal duct obstruction and lacrimal bony dysplasia who underwent endoscopic dacryocystorhinostomy (EN-DCR) at Beijing Children’s Hospital were deemed to be successfully cured or improved.
Patients who experienced lacrimal sac pore formation in the lateral nasal wall in front of the middle concha, epithelization under endoscopic observation, no tearing or pus, fluorescein dye disappearance test (FDDT) of 0 and smooth flush were considered cured. Improvement was considered when the patient had lacrimal sac pore formation in the lateral nasal wall in front of the concha, epithelization under endoscopic observation, symptom relief, FDDT of 1 and flush unobstructed or pressure flush unobstructed.
Cure rate was 41/50 (82%) with 9/50 (18%) showing improvement, making the procedure 100% successful for cure or improvement.
The CT scan “can precisely delineate the shape, direction, and abnormal structure of the bony nasolacrimal duct and provide a clear anatomical characterization of the abnormal nasolacrimal canal,” the study authors wrote.
Because congenital nasolacrimal canal dysplasia is a type of congenital nasolacrimal duct obstruction that does not respond to conservative and conventional treatment, the use of the CT scan to identify the abnormality in conjunction with EN-DCR provides an advantage over traditional lacrimal surgery, the authors said. – by Rebecca L. Forand
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Rudolph S. Wagner, MD
Persistent congenital nasolacrimal duct obstruction is usually managed successfully with probing and irrigation, balloon catheterization or silicone tube intubation. The authors implicate congenital nasolacrimal canal dysplasia (CNCD) as a cause of treatment failures. Although failures are not common, when they do occur the management is problematic. Dacryocystorhinostomy is difficult and can be disfiguring in young children. For this reason, many children are forced to live with epiphora. In this study, CT scans were used to diagnose anomalies of the bony nasolacrimal canal, which included atresia or stenosis. The images presented provide an anatomic explanation for why conventional probing may be difficult or impossible in some cases. The authors describe 50 cases of CNCD in 40 children that went on to further treatment. This is likely the largest study of endoscopic dacryocystorhinostomy (EN-DCR) in the pediatric population. The surgical technique is well described and illustrated. The results are excellent with a cure/improvement rate of 100%. The internal approach does not require any anastomotic support with a stent or tube since there is no canalicular involvement in the condition or surgical procedure. The approach avoids a second anesthesia to remove a silicone tube in these children. This is an important study that may change the management of failed primary procedures for congenital nasolacrimal duct obstruction.
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