Endoscopic dacryocystorhinostomy in children

Background: Persistent nasolacrimal duct obstruction (NLDO) often requires treatment by probing, intubation, or balloon dacryoplasty. Refractory cases have been managed by external dacryocystorhinostomy (DCR), which leaves a scar; however, this procedure is generally avoided in young children. Endos copic DCR has been successfully performed in adults and described in childr en. We report the success of this procedure in a series of pediatric patien ts. Methods: A retrospective review of ail endoscopic lacrimal procedures p erformed in a 3-year period was undertaken. Seventeen children (22 ducts) w ith persistent NLDO after at least one failed probing, with or without sili cone tube placement, underwent endoscopic DCR. Follow-up ranged from 6 to 3 6 months, and success was defined as resolution of tearing and discharge by follow-up clinical evaluation and by parental history. Results: All bur 2 patients (88%) with NLDO showed complete resolution of tearing and discharg e. These 2 patients had recurrent symptoms after the Crawford tubes were re moved and required revision endoscopic DCR. No complications from this proc edure were noted. Conclusions: Endoscopic DCR is a safe and effective means of treating persistent NLDO in infants and young children when simple prob ing, intubation, or balloon procedures have failed. The team ophthalmology- otolaryngology endoscopic approach provides a highly successful alternative for patients with a persistent distal obstruction that might otherwise req uire an external procedure.