Pediatric dacryocystorhinostomy for nasolacrimal duct obstruction

Objective: To determine the outcome of pediatric dacryocystorhinostomy (DCR ) for large mucoceles or for primary nasolacrimal duct obstruction unrespon sive to multiple probings. Design: Retrospective noncomparative case series. Participants: One hundred thirty-four external dacryocystorhinostomies were performed in 121 children. Methods: Clinical case notes were reviewed for a series of cases operated o n at Moorfields Eye Hospital by specialist lacrimal surgeons between 1987 a nd 1999. Main Outcome Measures: Postoperative relief of presenting symptoms and sign s and complications. Results: Fifty-nine percent of admissions (75 of 127) were day cases, and t he other 52 admissions were inpatient. Simultaneous bilateral surgery was p erformed in 7 of 121 (6%) children, all but one having day case admission, and sequential bilateral surgery in 6 of 121 (5%) cases. Silicone intubatio n was performed in 20% of operations, these generally being early in the se ries. Three children had Down syndrome, five had craniofacial anomalies, an d two had systemic disorders. Mild postoperative cellulitis occurred in thr ee cases, all of which settled without complication after systemic antibiot ic therapy, and there was one case of suture granuloma. There were no cases of immediate postoperative complication in either the day case or the inpa tient groups. Complete cure of symptoms was achieved in 96% and an improvem ent of symptoms (with mild persistence of epiphora under challenge) in five cases (4%). Conclusion: For surgeons experienced in pediatric lacrimal surgery, externa l DCR with sutured mucosal flaps can be accomplished through an 8-mm incisi on with no surface sutures and minimal scarring. Symptoms are improved in a ll cases and complete cure achieved in 96%, with no immediate postoperative complications and only few (3%) short-term complications. The surgery is a menable to day case management, without significant morbidity, and may be p erformed as a simultaneous bilateral procedure. (C) 2001 by the American Ac ademy of Ophthalmology.