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Abstract
Epiphora in infancy is commonly caused by congenital nasolacrimal duct obstruction. 20% of infants show mucous membrane obstruction at the lower end of the nasolacrimal duct. Spontaneous canalization of nasolacrimal duct usually occurs before the age of one year. Children who remain symptomatic after the age of one year are usually treated by nasolacrimal duct probing.
In the current study nasal endoscopy was used to assist nasolacrimal duct probing. We tried to highlight the role of nasal endoscopy in nasolacrimal duct probing in congenital nasolacrimal duct obstruction and to identify different sites of obstruction within lacrimal system.
This new technique was performed in different age groups (15-51 months) and in children with previous failed probing (2/15).
It was found that the Hasner valve obstruction was the most common site of obstruction (73.3%).
Follow up results at 3 weeks showed symptomatic improvement in 93.3% of lacrimal systems. Four cases showed mild tearing in windy atmosphere or with upper respiratory tract infection. The two cases with failed previous nasolacrimal duct probing showed complete resolution. This subjective improvement was confirmed by performing FDDT at 5 minutes. 39.3% of cases was within normal (grade 0 or +1).
The relationship between final outcome and different factors was studied. It was found that the site of obstruction at Hasner valve was associated with the best outcome. Also membranous obstruction was associated with the best outcome. On the other hand complex obstruction was found to be of worst prognosis. Other factors like age, gender, preoperative symptoms, laterality and the site of opening of nasolacrimal duct in the inferior meatus didn’t show a significant effect on final outcome .