CONGENITAL NASOLACRIMAL DUCT OBSTRUCTION AND ITS MANAGEMENT PROTOCOL

Abstract

PURPOSE: To determine management protocol in congenital nasolacrimal duct obstruction in age group of 3 months to 6 yrs . METHOD:A prospective interventional study was conducted on 30 patients with CNLDO within the age group 3 months to 6 yrs from September 2020 to April 2022. The diagnosis was made based on a history of epiphora since birth, or shortly after birth, in one or both eyes supported by objective evidence of reduced lacrimal outflow using a fluorescein dye disappearance test (FDDT). Ocular examination was carried out to exclude punctal stenosis or other abnormality. Patients with positive FDDT test were considered for various treatment modalities. Patients with age < 1 year considered for criggler massage 8-10 times a day. Patients with persistent epiphora and mucous discharge were considered for endoscopic assisted probing or DCR with intubation under general anaesthesia. RESULTS: The study group comprised of 30 patients, out of which 40 % were male and 60 % were female. On the basis of age of representation 60 % were between 12 months, 26 % between 1 year – 4 year and 14 % more than 4 years. In this study all patients were prescribed crigler massage but the patients not improved on massage and, 12 months - 4 years and more than 4 years were prescribed with endoscopic assisted probing, and DCR with intubation respectively. In this study out of 30 patients of CNLDO 16 patients were improved by crigler massage (in age group of < 12 months ) ,9 patients were improved with endoscopy assisted probing with 90 % of successful result in age group of 12 months - 4 years and 5 patients improved from DCR with intubation depending upon age of patients . CNLDO is a relative CONCLUSIONcommon disorder in peadiatric population ( 5 - 20 % ) due to failure of canalisation of the distal end of nasolacrimal duct leading to watery and mucoid discharge. Conservative management in the form of crigler massage considered to be safest and effective with higher success rate. Patients with no improvement on crigler massage and persistence of symptoms shows more effective outcome with endoscopic assisted probing or DCR with intubation.