Treatment of nasolacrimal duct obstruction in children with trisomy 21

Background: Nasolacrimal duct (NLD) obstruction and tear film abnormalities occur frequently in children with trisomy 21. This study describes the out comes of treatment for NLD obstruction in this population. Methods: The rec ords of 15 children with trisomy 21 treated for NLD obstruction were review ed. Eight patients were initially treated with NLD probing with or without placement of nonfixated lacrimal stents. Because of poor success with this procedure, the initial treatment of children with trisomy 21 and NLD obstru ction was changed to balloon catheter dilation in 1997. Outcomes were consi dered excellent if the patient had complete resolution of epiphora and dacr yocystitis, good if the patient had only mild residual symptoms, fair if th e patient had significant residual symptoms, and poor if there was no impro vement. Results: Of 8 patients treated initially with NLD probing, 5 had fa ir or poor outcomes. These patients all had good outcomes after placement o f nasally fixated lacrimal stents, balloon catheter dilation, or both. Of 7 patients treated initially with balloon catheter dilation, 5 had excellent or good outcomes and 2 had fair or poor outcomes. Conclusion: Simple NLD p robing is often unsuccessful in treating NLD obstruction in children with t risomy 21. Balloon catheter dilation appears to be a reasonable alternative first treatment in these patients.