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DISCUSSION
Congenital nasolacrimal duct obstruction may occur in as many as 2030% of new borns[1315]. However, only 16% of these Table 1Results of probing of 180 cases
children become symptomatic[13,14]. It is well documented that the commonest cause of congenital nasolacrimal obstruction at birth is a membranous obstruction at the distal end of nasolacrimal duct[1619]. Probing of the nasolacrimal duct is a standard therapeutic procedure in the management of the congenital nasolacrimal duct obstruction. Traditional options include office probing with topical anesthesia at the age of 46 months or observation and medical management followed by probing under general anesthesia at approximately 12 months[12]. This study was conducted to ascertain the optimal age of probing in congenital nasolacrimal duct obstruction.
A total of 214 eyes of 180 patients aged 424 months of age were included in the study. There was bilateral affection in 18.9% of the cases. Of these, 110 (61.1%) were males and 70 (38.9%) females. Hence, the number of males was almost double that of females. Kashkouli et al[7] reported 52.4% males and 47.6% females and 36.6% bilateral cases. In Halepotas study[3] the bilateral cases were 30%.
In this study, 194 out of 214 eyes (90.7%) were cured (Table 1). Halepota et al[3] reported a success rate of 95% and in Yaps study[20] the cure rate was 90%. Havins and Wilkins[21] demonstrated a success rate of 94% for probing done in children aged less than 8 months compared to 56% in children aged 18 months and older. Sturrock et al[22] reported 86% success when probing under one year compared to 72% between 1 and 2 years of age and 42% for more than 2 years of age. Casady et al[23] reported a success rate of 85% for probing in children more than 18 months of age.
Mannor et al[24] have also reported success rates of 92% in children aged 12 months and 89% in 24 months old.
In a comparative study of simple probing, simple syringing and combined probing and syringing of congenital nasolacrimal duct obstruction, the results were 91%, 64% and 96% in three respective groups[25]. The success rate of our study is comparable to the results of the third group.
One question that has confounded ophthalmologists is whether late probing affects the outcome of the procedure. Many ophthalmologists believe that the success rate decreases as the age increases. In one study, the success of nasolacrimal duct probing was negatively correlated with the increasing age. The results were 90%, 89%, 80%, 71% and 42% at ages of 12, 24, 36 and 48 months respectively[24].
Young et al[26]. achieved an overall success rate of 74%. Honavar et al[27]. reported the cure rate of 80%. There are also various studies which indicate that the cure rate does not vary significantly at intervals of increasing age[28]. The cure rates in our study compared well with those reported by Stager et al[29] for office probings in the first 12 months of life (92.4%), Katowitz and Welsh[10] for probings done during the first 13 months of life (95.9%) and Kassoff and Meyer[30], who also had good results with early probings. El Mansoury and colleagues[9] had a success rate of 93.5% in children over the ages of 13 months.
In our study, all the sixty patients of Group I had successful probing. In Group II, 62 out of 70 eyes were cured and in Group III 56 of 68 eyes remained asymptomatic (Table 1). These results are comparable to those found in literature. The success rate declines with the increasing age, but not significantly.
As observed by Robb[12], a simple probing for any untreated obstruction in a patient upto five years of age and occasionally beyond that is a reasonable first procedure. In this study favorable results were achieved in all the three age groups, but probing was found to be most successful when done before or upto the age of 6 months.
In conclusion, from this study it is concluded that the results of probing in different age groups declined as the patients age increased. The best result (100.0%) was achieved in those children who underwent the procedure before the age of six months. The procedure was carried out in general anesthesia which made the probing easy and safe in terms of few trauma and complications.
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