EVALUATION OF TREATMENT MODALITIES OF CONGENITAL NASOLACRIMAL DUCT OBSTRUCTION IN PAEDIATRIC PATIENTS FROM A TERTIARY EYE CARE CENTRE
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 19
Abstract
BACKGROUND Congenital nasolacrimal duct obstruction is a condition where there is non-canalisation of nasolacrimal duct at its lower end at the level of valve of Hasner. It is the most common cause of epiphora in new-borns occurring in 20% - 30% of the new-borns. About 1%- 6% of these children become symptomatic and the most common symptom is epiphora. Aims and Objectives- To study the demographic profile of the patients presenting with congenital nasolacrimal duct obstruction. To study the outcome of treatment modalities in patients with congenital nasolacrimal duct obstruction. MATERIALS AND METHODS This is a prospective observational study. A minimum of 110 eyes of children aged < 4 years with clinical diagnosis of congenital nasolacrimal duct obstruction with classical symptoms of epiphora and regurgitation of watering and discharge or both on pressure at lacrimal sac area were included in the study. Each patient was subjected to detailed history taking regarding the symptoms and duration of the symptoms. A careful and detailed examination of the eye was undertaken. All the patients those who were of age less than six months were first subjected to conservative treatment of lacrimal massaging at home after demonstration at hospital, thereafter, those who failed to respond to treatment upto the age of six months were subjected to syringing and probing under general anaesthesia. All cases were reviewed at 4th, 8th and 12th week. The patient was said to be cured if there was no recurrence of symptoms or discharge even after stoppage of antibiotics and massage for two weeks. RESULTS Out of 110 patients, 62 (56.3%) were males and 48 (43.6%) were females. Laterality- In 51 (46.3%) left eye was involved, in 20 (18.1%) right eye was involved and in 39 (35.4%) there was bilateral involvement. Mean Age- Mean age of presentation was 3.9 months. Socio-Economic Status- 36 (32.7%) children belonged to Poor socio-economic strata. 40 (36.3%) patients were from Middle socioeconomic strata and 34 (30.9%) patients belonged to Higher socio-economic strata. Referral Pattern- 60 (54.5%) patients were referred by paediatricians after initial treatment, 12 (10.9%) patients were brought by their parents on their own. 38 (34.5%) patients were referred by Registered Medical Practitioners. Success Rate- 102 (92.7%) of the children were relieved of their symptoms within 12 weeks of conservative treatment. Only 8 children, i.e. 7.2% who could not get relieved of their symptoms even after the age of 6 months. Out of these 8 patients, symptoms were relieved in 5 patients with single syringing and probing only. Two patients required syringing and probing twice to get their symptoms relieved and only one patient was not cured. CONCLUSION With this study, we conclude that nasolacrimal duct massage has a very high success rate and should be started as early as possible to be more effective. The syringing and probing also have high success rate and should be started as early as six months of age to avoid the morbidity of epiphora and risk of dacryocystitis.
Authors and Affiliations
Sanjay Kai, Bhavani Raina, Pallavi Sharma
Keywords
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- EP ID EP418198
- DOI 10.14260/jemds/2018/526
- Views 101
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