Reappraisal of probing of the congenital obstruction of the nasolacrimal system: is nasal endoscopy essential?

Objective: The rate of false passages during probing for congenital nasolac rimal system obstruction (CNLO) is a major limiting factor for a successful outcome. This shortcoming may be decreased with the use of a nasal endosco pe during probing. This approach is particularly important in the probing t raining of ophthalmology residents. Methods: An experienced pediatric ophth almologist performed probings on 11 eyes, and a group of ophthalmology resi dents under his supervision performed probings on another 11 eyes for CNLO. Their claims of a successful or unsuccessful procedure were evaluated with nasal endoscopy by an ear-nose-throat (ENT) surgeon. The age range of the patients was 8-23 months. Results: The ophthalmologist made two false passa ges, one of which he was aware. out of 11 eyes. The residents had five fals e passages, two of which were unclear to them, out of another 11 eyes. No f alse passages occurred in obstructions at the level of the Hasner valve. No ne of the successful probings required more than a 30 mm probe introduction into the nasolacrimal canal from the inferior punctum. Conclusion: It seem s justified to have a nasal endoscopic evaluation, performed by an ENT surg eon. for probings during the training program of ophthalmology residents. D ifficult cases with stenosis proximal to the inferior meatus, prior false p assage experience on a particular case, and any indication for silicone tub e implantation will benefit from the use of an endoscope during the procedu re. In order to achieve the best results in CNLO, the collaborative teamwor k of an ophthalmologist and an ENT specialist is necessary. (C) 2001 Elsevi er Science Ireland Ltd. All rights reserved.