Pattern and outcome of surgical management of nasolachrymal duct obstruction in children: A five year review

Abstract

Objective: To determine the pattern of naso.lachrymal duct obstruction (NLDO) and outcome of dacryocystorhinostomy (DCR) in children in Aminu Kano Teaching Hospital Kano, over a 5.year period.
Patients and Methods: The clinic and theater registers were used to retrieve the records of all patients below the age of 15 years who presented with NLDO. The information obtained included age, sex, duration, and types of clinical signs at presentation cause of obstruction and outcome of DCR. Successful outcome is defined as patent naso.lachrymal duct 1 year after surgery. All the patients had external DCR with stent inserted into the lachrymal sac and anchored to the columella and left in situ for 6 weeks. Fortnightly for three visits then at 2 months intervals. At each visit, the patient had lachrymal punctal cannulation and irrigation with normal saline to ensure free drainage.
Results: There were 17 patients, 9 males and 8 females (M: F = 1.1: 1). Two patients (11.8%) had bilateral disease and 15 (88.2%) were unilateral. The patientsf ages ranged between 2 and 10 years. The commonest presenting features were tearing and discharge. In 14 patients (82%) tearing started from birth though patients presented much later. Congenital NLDO occurred in 82%, and in the remaining 18%, obstruction was caused by depressed nasal fracture. Fifteen patients (88%) had successful outcome of DCR at 1.year follow.up. The commonest  complication noted was stent extrusion before 6 weeks in 17.6% of cases.
Conclusion: NLDO was mostly of congenital origin and was characterized by delayed presentation. Patients have good outcome with external DCR.

Keywords: Children, dacryocystorhinostomy, naso lachrymal duct,  obstruction