External dacryocystorhinostomy in paediatric age group: indications and outcome results

Abstract

Introduction Management of epiphora in children is a stepwise process, starting with probing after age of 1 year and it provides a high cure rate. Nasolacrimal intubation is recommended when symptoms persist after two probings. For persistent epiphora following probing and intubation, more invasive procedure is required like balloon dacryocystoplasty, or external and endonasal dacryocystorhinostomy. Objective This study was designed to evaluate the indications and surgical outcome of external dacryocystorhinostomy in the paediatric age group. Design A retrospective case series study that was carried out in the oculoplastic unit in Minia University Hospital including children undergoing external dacryocystorhinostomy (DCR) in a 5-year period (from June 2008 to June 2013). Patients and methods Data of all patients who underwent external DCR with silicone intubation in a 5-year period were retrospectively reviewed. Patients aged 15 years or less were chosen for the study and data collected were age and sex of the patients, side of the obstruction, indication for surgery, follow-up period and postoperative results and complications. Criteria of success were disappearance of epiphora, discharge and/or the mucocele in addition to negative fluorescein dye disappearance test and patent lacrimal passages on syringing and probing. The follow-up period was at least 6 months. Data of 29 patients were retrieved and the patients were categorized into two subgroups according to the cause of obstruction: congenital group (17 patients) and acquired group (12 patients) and the collected data were statistically analysed. Results Seventeen (58.6%) out of the 29 patients had congenital causes of epiphora, whereas 12 (41.4%) patients had acquired causes. Age of the patients ranged from 6 to 180 months with a mean of 78 months. Males were slightly more (53%) in the congenital subgroup, whereas 58% of the patients in the acquired subgroup were females and the overall male to female ratio in all patients was nearly 1 : 1. The overall success rate in all patients was 89%, which was higher in the congenital subgroup (94%) than in the acquired subgroup (83%). Conclusion External DCR yielded good results with minimal complications regarding epiphora in children. The results were better in patients with congenital causes than acquired causes.

Keywords

• Acquired obstruction
• congenital obstruction
• external dacryocystorhinostomy
• paediatric