The role of nasal endoscopy in repeat pediatric nasolacrimal duct probings

Purpose: To determine whether pediatric nasal endoscopy improves treatment success in recurrent nasolacrimal duct obstruction. Methods: A retrospectiv e analysis was carried out on 2 nonrandomized cohorts of consecutively trea ted patients who had one failed nasolacrimal duct probing at the Hospital f or Sick Children, University of Toronto. The first cohort of 24 consecutive patients (32 eyes), group A, was treated with Crawford silicone tube intub ation by one ophthalmologist (R.C.P.). The second cohort of 23 consecutive patients (33 eyes), group B, was treated with repeat probing by a second op hthalmologist (A.V.L.) in conjunction with nasal endoscopy by one otolaryng ologist (V.F.). Abnormalities found on endoscopy were treated accordingly, and no tubes were inserted. Follow-up, through phone interviews or office v isits, was conducted to assess the patients' symptoms. Results: Group A pat ients were older at both the first probing (P=.048) and the second procedur e (P=.012). No significant difference in the failure rates was found, with treatment failing in 3 eyes (2 patients) in group A and in 5 eyes (4 patien ts) in group B (P =.479). Interestingly, 17 of the 32 tubes in group A were extruded in 1 month or less. Also, 28 of 33 eyes in group B had abnormalit ies on endoscopy-some, multiple. Twenty-two eyes underwent inferior turbina te infracture: 5 had redundant mucosa, which was removed, and 6 had abnorma l openings of the inferior meatus. Conclusions: We were unable to show any benefit of nasal endoscopy over intubation of the nasolacrimal system with silicone tubes in the treatment of failed probings despite the identificati on and treatment of abnormalities. The study was limited by its low power t o detect differences because of the small number of patients and the high s uccess rate of the traditional treatments for congenital nasolacrimal duct obstruction.