A total of 130 eyes of 130 children with CNLDO were evaluated in this retrospective analysis; 50 were female (38.5%) and 80 were male (61.5%).
Overall, 46 patients (35.4%) had bilateral symptoms, and 84 (64.6%) were unilateral. Selecting the more severely affected eye shows that 68 (52.3%) were right eyes and 62 (47.8%) were left eyes.
The demographic profile of all four age groups A–D is summarized in Table 1.
Upon referral to our institution, 103 eyes (79.2%) were treatment-naïve, except for Crigler’s lacrimal sac compression. In total, 27 eyes (20.8%) were referred to us receiving additional treatment after an undetermined period of unsuccessful Crigler’s lacrimal sac compression; two eyes (1.5%) were treated with topical antibiotics (gentamicin), 13 eyes (10.0%) received constringent eye drops (naphazoline in water and artificial tears; Oculotect fluid, Thea Pharma GmbH, Vienna, Austria), and 12 eyes were treated with combination therapy: in eight eyes (6.2%) topical antibiotics and constringent eye drops were prescribed, three eyes (2.3%) were treated with continued lacrimal sac massage combined with constringent eye drops, and one patient (0.8%) received systemic antibiotics with topical antibiotics as well as constringent eye drops.
All eyes scheduled for intervention were examined under general anesthesia (100%), which enabled precise differentiation between simple CNLDO (73.1%, 95 eyes) and complex CNLDO (26.9%, 35 eyes), which are presented in detail in Fig. 1. Complex CNLDO comprised bony NLDO (11.5%, 15), complete canalicular obstruction (7.7%, 10), atresia of the punctum (5.4%, 7), as well as complete common canalicular obstruction (2.3%, 3). There was no statistically significantly difference in age between the simple and complex groups (p = 0.08).
The two most common approaches used were initial probing (86.9%, 113 eyes) and DCR (10%, 13 eyes; see Fig. 1). But punctoplasty (2.3%, 3 eyes) and canalicular curettage (0.8%, 1 eye) were also applied.
Figure 2 shows lacrimal drainage system intubations used. Bicanalicular silicone intubation (BSI) was most commonly applied (46.9%, 61 eyes), followed by monocanalicular intubation (Monoka; FCI S.A.S. France; 35.4%, 46 eyes); 23 eyes (17.7%) did not receive intubation of the lacrimal drainage system.
There were statistically significant differences between age groups regarding the time until intervention (p < 0.0001, ANOVA). Patients aged between two and 6 months (group A) at initial presentation were scheduled for surgical intervention after a median time of 270 (CI: 178–452) days. Patients aged between 6 and 12 months (group B), older than 1 year (group C), and patients aged over 2 years (group D) had a similar waiting time for surgical intervention of 122 (68–135) days, 135 (97–176) days, and 161 (127–215) days, respectively. Statistically significant differences between groups were only found when comparing group A with all other groups (all p < 0.0001).
A detailed summary of treatment prescribed postoperatively is given in Table 2. The most frequent postoperative medication used was a combination of dexamethasone and gentamicin with naphazoline eye drops (36.9%), antibiotic ointment (29.2%), or dexamethasone and gentamicin eye drops (16.2%).
Regarding clinical appearance 1 month after surgical intervention, no occurrences were noted in 85.9% of eyes. In nine of 61 eyes (14.8%) receiving BSI, the bicanalicular silicone tube used was lost; 6.2% (8 eyes) presented with local inflammation, swelling, or dislocation of the silicone tube. One patient experienced bleeding (0.8%).
The most frequent symptoms reported 3 months after surgical intervention were epiphora (6.9%, nine children), NLDO (6.2%, eight children), local inflammation (3.8%, five children), and closure of the lacrimal punctum (2.3%, three children).
Of the eight children scheduled for re-operation, six were planned to undergo balloon dacryoplasty with BSI and two received an appointment for conjunctivodacryocystorhinostomy (CDCR). Of these eight children, only five (two for CDCR and three for balloon dacryoplasty with BSI) appeared for reoperation; in three, the problems resolved with no need for further treatment.
Consequently, we calculated an overall success rate of 96% based on the evaluation of 130 eyes. Table 3 summarizes the success rates for groups A–D. There is no statistically significant difference in success rates between simple and complex NLDO (p = 0.13). There is also no statistically significant difference in success rates between surgeons (p = 0.72).