Blind Bi-canalicular Intubation Versus Endoscopic Guided Intubation in Treatment of Nasolacrimal Duct Obstruction in Children

Document Type : Original Article

Authors

1 Department of Ophthalmology, Baltim General Hospital, Ministry of Health, Baltim, Egypt

2 Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Abstract

Background: Congenital nasolacrimal duct obstruction is a common cause of epiphora in pediatrics. Probing is the primary treatment option. However, failure rate is high. Thus, many options are introduced without consensus on the optimal management option.
The Aim of the work: The current work aiming to compare blind bicanalicular intubation and endoscopic guided intubation in treatment of pediatric nasolacrimal duct obstruction.  
Patients and Methods: Fifty eyes with congenital nasolacrimal duct obstruction [CNLDO] were included. The preoperative assessment include history taking, clinical examination and complete ophthalmological examination. The Munk scale was used for grading of epiphora. Patients were grouped into two equal groups. The first treated by blind bicanalicular intubation, and the second treated by endoscopic guided intubation.  Patients were followed up on the first day, first week, first, third and sixth months in the absence of complications. The postoperative evaluation included Munk score, tear meniscus height, fluorescein dye disappearance test, discharge, bleeding, and subjective patient satisfaction.
Results: The study groups were comparable regarding patient age, sex, laterality of the obstruction and assessment scores or tests. However, there was progressive improvement in both groups at the end of follow up compared to preoperative values. The percentage of reduction of Munk score and TMH was higher in endoscopic guided intubation. The improvement of FDDT was achieved for 92.0% in endoscopic group, compared to 88% of the blind bi-canalicular group. Postoperative bleeding was significantly higher among blind than endoscopic groups [24% vs 4.0% respectively]. The recurrence rate was higher among blind than endoscopic groups [12% vs 8%].
Conclusion: Silicone intubation of nasolacrimal duct with nasal endoscopy had favorable results than blind bicanalicular intubation, as a primary treatment of persistent congenital NLDO in children between 2-6 years of age.

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