Congenital nasolacrimal duct obstruction.

Opinions have diverged for more than 2 centuries as to the appropriate treatment regarding the nature, timing and anesthesia for congenital nasolacrimal duct obstruction.

 

Roughly speaking, three attitudes coexist :

 

 

 

(1) Approximately 90% of children with congenital nasolacrimal duct obstruction recover spontaneously by 1 year of age, which many surgeons believe justifies waiting at least until this time before intervening surgically.

 

(2) Other authors believe, however, that, on the contrary, congenital nasolacrimal duct stenoses will worsen over time due to chronic inflammation. These authors advise that treatment be chosen based on the child’s age at consultation and recommend early office probing up to approximately 6 months of age. After 1 year of age, however, probing under a general anesthetic in the operating room is recommended as a first step, followed by nasolacrimal stenting, or balloon dacryoplasty if this is unsuccessful, and then a DCR if the previous steps fail.

 

(3) Still other authors claim that it is not the child’s age that is important but the severity of the nasolacrimal obstruction noted at the time of probing.

They make a distinction between complex obstructions requiring balloon dacryoplasty and/or silicone intubation versus  simple valve of Hasner mucosal obstructions at the distal end of the nasolacrimal duct. These authors claim that such distal mucosal obstructions will respond  even after an initial simple probing at age 4 or 5 years. They recommend careful probing in the operating room,  under general anesthesia  for probing up to 36 or even 48 months.

 

 

A new type

of stenting technique :

the Masterka,

offers an exciting alternative

which can be done

with

masked ventilation alone.

 

 

 

 

 

 



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