Jornal de Oftalmologia Clínica e Experimental
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Dacryoendoscopy for Lacrimal Duct Obstruction Manifesting In Childhood

Heichel J, Bredehorn-Mayr T, Stuhltraeger U and Struck HG

Purpose: To evaluate the results of dacryoendoscopy as a diagnostic and therapeutic option for lacrimal duct obstruction manifesting in childhood.
Methods: Retrospective, non-comparative analysis of 50 dacryoendoscopies performed on 43 eyes of 35 children. All children have had lacrimal surgery (probing and/or intubation) at least twice before. Mean age was 34.1 months (range, 1-104). Thirty-five eyes could be included for follow-up which ranged from 3 to 61 months (mean, 25.8).
Results: Indications for treatment were: chronic dacryocystitis because of congenital nasolacrimal duct obstruction (CNLDO) (n=40) under which three eyes showed iatrogenic foreign bodies, presaccal stenosis (n=5), amniotocele (n=3), and lacrimal fistula (n=2). Dacryoendoscopy was performed as therapeutic (n=38) or diagnostic (n=12) intervention. Surgery was performed as primary (n=43) or secondary (n=7) endoscopy. Complication rate was 2% (n=1). Seven eyes (16.3%) required dacryocystorhinostomy (DCR). Three of these showed recurrence of symptoms, two had bony stenosis, and two eyes were treated twice by transcanalicular endoscopic intervention showing persisting chronic dacryocystitis. Thirty-five of 43 primary endoscopies were performed as a therapeutic intervention. Thirty-two of these eyes (91.4%) were treated successfully by dacryoendoscopy.
Conclusions: Dacryoendoscopy performed in children offers additive diagnostic and therapeutic options. Advantages are visual control with preservation of topographic anatomy due to its minimally-invasive character. Our analysis gives evidence that after an initial failure, a second endoscopic intervention has a reduced likelihood for cure. Proving this further data is needed. Performed by experienced surgeons it is a safe technique.