Mono-canalicular Lacrimal Stent Intubation for Congenital Nasolacrimal Duct Obstruction Treatment

Abstract

Background Epiphora, marked by tear overflow at the eyelid margin, is a prevalent condition in ophthalmology, affecting over 20% of infants. The causes involve hypersecretion due to anterior segment diseases or compromised lacrimal drainage systems. While congenital nasolacrimal duct obstruction (CNLDO) in children often resolves spontaneously, persistent cases may necessitate surgical intervention. The management, which includes probing, stent insertion, and dacryocystorhinostomy, remains challenging due to the miniaturized and variable anatomy of the lacrimal pathways. Objective and Aims This study aims to investigate the efficacy of mono-canalicular Lacrijet stent insertion in managing congenital nasolacrimal duct obstruction (CNLDO) in pediatric patients, particularly those aged over 24 months. It focuses on assessing success rates in cases with prior probing or no previous probing. The study aims to contribute valuable insights to the existing literature on the effectiveness of Lacrijet intubation as a management option for CNLDO. Patients and Methods A prospective observational study following 25 pediatric patients diagnosed with epiphora in an ophthalmology hospital. The procedure included using mono-canalicular Lacrijet intubation. Patients were followed for 180 days post-operatively via subjective and objective measures. Independent and paired t-tests were used for numerical variables. Chi-square was applied to check the significant association of variables with outcome. A p-value less than or equal to 5% is considered significant. Results More than half of the sample was 3-6 years of age (56%), males (52%), and had previous probing attempts (56%). Seven (28%) patients were relieved from symptoms within less than 5 days, 12 (48%) recovered within 5-9 days, and 2 (8%) patients were symptom-free after 10 days. The success rate was 84%. Only 4 patients (16%) had unsuccessful outcomes. There was no significant difference in outcome regarding patients’ age, gender, affected eye, previous probing, and site of intubation. Conclusions and Recommendations Mono-canalicular Lacrijet stent insertion appears as a simple, safe, and reliable outpatient procedure for treating CNLDO in children. Age and prior failed probing did not significantly impact success rates. Early and detailed assessments are recommended for children with epiphora, with consideration for mono-canalicular stenting. Future research could compare outcomes between probing and intubation as initial treatments for pediatric epiphora.