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Congenital Nasolacrimal Duct Obstructions

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Principles and Practice of Lacrimal Surgery

Abstract

Congenital nasolacrimal duct obstruction (CNLDO) is a common cause of epiphora in children. Management of CNLDO is principally guided by natural history of disease and high spontaneous remission rate by 1 year of age. The standard of care now for non-resolving cases is endoscopic-assisted probing with or without intubation. There is an increasing role of dacryoendoscopy and simultaneous correction of associated intranasal abnormalities.

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References

  1. Geurry D, Kendig EL. Congenital impatency on the naso-lacrimal duct. Arch Ophthalmol. 1948;39:193–204.

    Article  Google Scholar 

  2. Macewen CJ, Young JDH. Epiphora during the first year of life. Eye. 1991;5:596–600.

    Article  PubMed  Google Scholar 

  3. Cassady JV. Developmental anatomy of nasolacrimal duct. Arch Ophthalmol. 1952;47:141–58.

    Article  CAS  Google Scholar 

  4. Wallace EJ, Cox A, White P, et al. Endoscopic-assisted probing for congenital nasolacrimal duct obstruction. Eye. 2006;20:998–1003.

    Article  CAS  PubMed  Google Scholar 

  5. Lueder GT. Endoscopic treatment of intranasal abnormalities associated with nasolacrimal duct obstruction. J AAPOS. 2004;8:128–32.

    Article  PubMed  Google Scholar 

  6. dela Cuadra-Blanco C, Peces-Pena MD, Janez-Escalada L, et al. Morphogenesis of the human excretory lacrimal system. J Anat. 2006;209:127–35.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Takahashi Y, Matsuda H, Nakamura Y, et al. Dacryoendoscopic findings of lacrimal passage with congenital punctal atresia. Orbit. 2013;32:338–40.

    Article  PubMed  Google Scholar 

  8. Jones LT, Wobig JL. Surgery of the eyelids and lacrimal system. Birmingham, Alabama: Aesculapius; 1976. p. 162–4.

    Google Scholar 

  9. Kushner BJ. The management of nasolacrimal duct obstruction in children aged between 18 months and 4 years. JAAPOS. 1998;2:57–60.

    CAS  Google Scholar 

  10. Perry LJ, Jakobiec FA, Zakka FR, et al. Giant dacryocystomucopyocele in an adult: a review of lacrimal sac enlargements with clinical and histopathologic differential diagnoses. Surv Ophthalmol. 2012;57:474–85.

    Article  PubMed  Google Scholar 

  11. Paysee EA, Coats DK, Bernstein JM, et al. Management and complications of congenital dacryocele with concurrent intranasal mucocele. JAAPOS. 2000;4:46–53.

    Google Scholar 

  12. MacEwen CJ, Young JD, Barras CW, et al. Value of nasal endoscopy and probing in the diagnosis and management of children with congenital epiphora. Br J Ophthalmol. 2001;85:314–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ali MJ, Psaltis AJ, Brunworth J, et al. Congenital dacryocele with large intranasal cysts. Efficacy of cruciate marsupialization, adjunctive procedures and outcomes. Ophthal Plast Reconstr Surg. 2014;30:346–51.

    Google Scholar 

  14. Francois J, Bacskulin J. External congenital fistulae of the lacrimal sac. Ophthalmologica. 1969;9:249–61.

    Article  Google Scholar 

  15. Welham RAN, Bergin DJ. Congenital lacrimal fistulas. Arch Ophthalmol. 1985;103:545–8.

    Article  CAS  PubMed  Google Scholar 

  16. Freitag SK, Woog JJ. Congenital nasolacrimal duct obstruction. Ophthal Clin N Am. 2000;13:705–18.

    Article  Google Scholar 

  17. Young JD, MacEwen CJ, Ogston SA. Congenital nasolacrimal duct obstruction in the second year of life: a multicentre trial of management. Eye. 1996;10:485–91.

    Article  PubMed  Google Scholar 

  18. Paediatric Eye Disease Investigator Group. Resolution of congenital nasolacrimal duct obstruction with nonsurgical management. Arch Ophthalmol. 2012;130:730–4.

    Google Scholar 

  19. Schnall BM. Paediatric nasolacrimal duct obstruction. Curr Opin Ophthalmol. 2013;24:421–4.

    Article  PubMed  Google Scholar 

  20. Paediatric Eye Disease Investigator Group. A randomized trial comparing the cost-effectiveness of two approaches for treating unilateral nasolacrimal duct obstruction. Arch Ophthalmol. 2012;130:1525–33.

    Article  Google Scholar 

  21. PEDIG. Primary treatment of nasolacrimal duct obstruction with probing in children less than four years. Ophthalmology. 2008;115:577–84.

    Article  Google Scholar 

  22. Honavar SG, Prakash VE, Rao GN. Outcome of probing for congenital nasolacrimal duct obstruction in older children. Am J Ophthalmol. 2000;130:42–8.

    Article  CAS  PubMed  Google Scholar 

  23. Maheshwari R. Success rate and causes of failure for late probing for congenital nasolacrimal duct obstruction. J Pediatr Ophthalmol Strabismus. 2008;45:168–71.

    Article  PubMed  Google Scholar 

  24. Paediatric Eye Disease Investigator Group. Primary treatment of nasolacrimal duct obstruction with balloon catheter dilation in children less than four years old. JAAPOS. 2008;12:451–5.

    Google Scholar 

  25. Ali MJ, Naik MN, Honavar SG. Balloon dacryoplasty: ushering the new and routine era in minimally invasive lacrimal surgeries. Int Ophthalmol. 2013;33:203–10.

    Google Scholar 

  26. Paediatric Eye Disease Investigator Group. Primary treatment of nasolacrimal duct obstruction with nasolacrimal duct intubation in children less than four years old. JAAPOS. 2008;12:445–50.

    Google Scholar 

  27. Kashkouli MB, Beigi B, Parvaresh MM, et al. Late and very late initial probing for congenital nasolacrimal duct obstruction: what is the cause of failure? Br J Ophthalmol. 2003;87:1151–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Paediatric Eye Disease Investigator Group. Repeat probing for treatment of persistent nasolacrimal duct obstruction. JAAPOS. 2009;13:306–7.

    Google Scholar 

  29. Repka MX, Chandler DL, Holmes JM, Paediatric Eye Disease Investigator Group, et al. Balloon catheter dilation and nasolacrimal duct intubation for treatment of nasolacrimal duct obstruction after failed probing. Arch Ophthalmol. 2009;127:633–9.

    Article  PubMed  Google Scholar 

  30. Sasaki T, Nagata Y, Sugiyama K. Nasolacrimal duct obstruction classified by dacryoendoscopy and treated with inferior meatal dacryorhinotomy: part II. Inferior meatal dacryorhinotomy. Am J Ophthalmol. 2005;140:1070–4.

    Article  PubMed  Google Scholar 

  31. Emmerich KH, Steinhauer J, Meyer-Rüsenberg HW, et al. Dacryoendoscopy–current status. Ophthalmologe. 1998;95:820–2.

    Article  CAS  PubMed  Google Scholar 

  32. Leibovitch I, Selva D, Tsirbas A, et al. Paediatric endoscopic endonasal dacryocystorhinostomy in congenital nasolacrimal duct obstruction. Graefes Arch Clin Exp Ophthalmol. 2006;244:1250–4.

    Article  PubMed  Google Scholar 

  33. Lin AE, Chan YC, Lin MY, et al. Comparison of treatment for congenital nasolacrimal duct obstruction: a systematic review and meta-analysis. Can J Ophthalmol. 2016;51:34–40.

    Article  PubMed  Google Scholar 

  34. Matta NS, Singman NL, Silbert DI. Prevalence of amblyopia risk factors in congenital nasolacrimal duct obstruction. J AAPOS. 2010;14:386–8.

    Article  PubMed  Google Scholar 

  35. Ramkumar VA, Agarkar S, Mukherjee B. Nasolacrimal duct obstruction: does it really increase the risk of amblyopia in children. Indian J Ophthalmol. 2016;64:496–9.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Siddiqui SN, Mansoor H, Asif M, et al. Comparison of anisometropia and refractive status in children with unilateral and bilateral congenital nasolacrimal duct obstruction. J Pediatr Ophthalmol Strabismus. 2016;53:168–72.

    Article  PubMed  Google Scholar 

  37. Bagheri A, Safapoor S, Yazdani S, et al. Refractive status in children with unilateral congenital nasolacrimal duct obstruction. J Ophthalmic Vis Res. 2012;7:310–5.

    PubMed  PubMed Central  Google Scholar 

  38. Kim JW, Lee H, Chang M, et al. Amblyopia risk factors in children with congenital nasolacrimal duct obstruction. J Craniofac Surg. 2013;24:1123–5.

    Article  PubMed  Google Scholar 

  39. Son MK, Hodge DO, Mohney BG. Timing of congenital dacryostenosis resolution and the development of anisometropia. Br J Ophthalmol. 2014;98:1112–5.

    Article  Google Scholar 

  40. Eshraghi B, Akbari MR, Fard MA, et al. The prevalence of amblyogenic factors in children with persistent congenital nasolacrimal duct obstruction. Graefes Arch Clin Exp Ophthalmol. 2014;252:1847–52.

    Article  CAS  PubMed  Google Scholar 

  41. Ali MJ, Kamal S, Gupta A, et al. Simple vs complex congenital nasolacrimal duct obstruction: etiology, management and outcomes. Int Forum Allergy Rhinol. 2015;5:174–7.

    Google Scholar 

  42. Gupta A, Kamal S, Javed Ali M, et al. Buried probe in complex congenital nasolacrimal duct obstruction: clinical profiles and outcomes. Ophthal Plast Reconstr Surg. 2015;31:318–20.

    Google Scholar 

  43. Kamal S, Ali MJ, Gupta A, et al. Lacrimal and nasal masquerades of congenital nasolacrimal duct obstruction: etiology, management and outcomes. Int Ophthalmol. 2015;35:807–10.

    Google Scholar 

  44. Ali MJ, Kamal S, Vemuganti GK, et al. Glial heterotropia or ectopic brain masquerading as a congenital dacryocystocele. Ophthal Plast Reconstr Surg. 2015;31:e26–8.

    Google Scholar 

  45. Zhang C, Wu Q, Cui Y, et al. Anatomy of nasolacrimal canal in congenital nasolacrimal duct obstruction–18 cases retrospective study. Acta Ophthalmol. 2015;93:e404–5.

    Article  PubMed  Google Scholar 

  46. Kim YH, Lee YJ, Song MJ, et al. Dacryocystocele on prenatal ultrasonography: diagnosis and postnatal outcomes. Ultrasonography. 2015;34:51–7.

    Article  PubMed  Google Scholar 

  47. Machado MA, Abreu Junior LD, Silva JA, et al. Congenital dacryocystocele: diagnosis using ante and post-natal ultrasonography. Arq Bras Oftalmol. 2014;77:261–3.

    Article  PubMed  Google Scholar 

  48. Li SL, Luo GY, Tian XX, et al. Prenatal diagnosis and perinatal outcome of congenital dacryocystocele: a large case series. Prenat Diagn. 2015;35:103–7.

    Article  CAS  PubMed  Google Scholar 

  49. Kim H, Park J, Jang J, et al. Urgent bilateral endoscopic marsupialization for respiratory distress due to bilateral dacryocystitis in a newborn. J Craniofac Surg. 2014;25:e292–3.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Durmaz A, Yildizoglu U, Arslan F, et al. Bilateral dacyrocystocele with an intranasal cyst as the cause of respiratory distress in a newborn. B-ENT. 2016;12:23–7.

    CAS  PubMed  Google Scholar 

  51. Kuboi T, Okazaki K, Kusaka T, et al. Congenital dacryocystocele controlled by nCPAP via nasal mask in a neonate. Pediatr Int. 2015;57:475–7.

    Article  PubMed  Google Scholar 

  52. Barham HP, Wudel JM, Enzenauer RW, et al. Congenital nasolacrimal duct cyst/dacyrocystocele: an argument for a genetic basis. Allergy Rhinol. 2012;3:e46–9.

    Article  Google Scholar 

  53. Plaza G, Nogueira A, Gonzalez R, et al. Surgical treatment of familial dacryocystocele and lacrimal puncta agenesis. Ophthal Plast Reconstr Surg. 2009;25:52–3.

    Article  PubMed  Google Scholar 

  54. Wang JC, Cunningham MJ. Congenital dacryocystocele: is there a familial predisposition? Int J Pediatr Otorhinolaryngol. 2011;75:430–2.

    Article  PubMed  Google Scholar 

  55. Bernardini FP, Cetinkaya A, Capris P, et al. Orbital and periorbital extension of congenital dacryocystoceles: suggested mechanism and management. Ophthal Plast Reconstr Surg. 2016;32:e101–4.

    Article  PubMed  Google Scholar 

  56. Spaniol K, Stupp T, Melcher C, et al. Association between CNLDO and delivery by cesarian section. Am J Perinatol. 2015;32:271–6.

    PubMed  Google Scholar 

  57. Kuhli-Hattenbach C, Luchtenberg M, Hoffman C, et al. Increase prevalence of dacryostenosis following cesarian sections. Ophthalmologe. 2016;113:675–83.

    Article  CAS  PubMed  Google Scholar 

  58. Foster J 2nd, Kapoor S, Diaz-Horta O. Identification of an IGSF3 mutation in a family with congenital nasolacrimal duct obstruction. Clin Genet. 2014;86:589–91.

    Article  CAS  PubMed  Google Scholar 

  59. Brunner HG, Hamel BC, van Bokhoven H. The p63 gene in EEC and other syndromes. J Med Genet. 2002;39:377–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Allen RC. Hereditary disorders affecting the lacrimal system. Curr Opin Ophthalmol. 2014;25:424–31.

    Article  PubMed  Google Scholar 

  61. Jadico SK, Huebner A, McDonald-McGinn DM, et al. Ocular phenotype correlations in patients with TWIST versus FGFR3 genetic mutations. J AAPOS. 2006;10:435–44.

    Article  PubMed  Google Scholar 

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Correspondence to Mohammad Javed Ali F.R.C.S .

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Kamal, S., Ali, M.J., Gauba, V. (2018). Congenital Nasolacrimal Duct Obstructions. In: Ali, M. (eds) Principles and Practice of Lacrimal Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-10-5442-6_14

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  • DOI: https://doi.org/10.1007/978-981-10-5442-6_14

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