Dilation probing as primary treatment for congenital nasolacrimal duct obstruction

Purpose: Recent studies have suggested that simple nasolacrimal duct (NLD) probing can be an effective primary surgery for congenital NLD obstruction regardless of age. The success of balloon dilation after failed NLD probing suggests that maximally enlarging the passage through the NLD system may enhance the success of simple NLD probing. This study used sequential probing with modified, taper-tip probes to evaluate whether maximally enlarging the nasolacrimal duct can effectively treat congenital NLD obstructions in all age groups. Methods: Under general anesthesia, each obstructed NLD system was sequentially probed with larger diameter NLD probes until firm resistance prevented the passage of any larger probe size. Successful treatment was defined as a negative dye-disappearance test 2 weeks after probing and the absence of tearing symptoms at last contact. Results: A retrospective chart review identified 40 patients ages 6 to 32 months (average, 17.7 months) who underwent the sequential probing procedure. Sequential NLD probing was successful in 66 (92%) of 72 eyes. Of the failures, both eyes in a 15-month-old patient with Down's syndrome had tight, anomalous NLD systems. In the remaining 4 eyes, 2 had resolution of symptoms but partially positive dye-disappearance tests, and 2 underwent successful repeat sequential NLD probing. Subdividing by age, 27 (100%) of 27 obstructed NLD systems were treated successfully in patients older than 18 months compared with 39 (87%) of 45 in younger patients, Conclusion: Sequential NLD probing to maximally enlarge the NLD system has a high rate of success in all children. Age does not appear to have an impact on success of probing.