Management of congenital nasolacrimal duct obstruction: comparison of probing vs conservative medical approach

The treatment of congenital nasolacrimal duct obstruction [CNLDO] continues to be a subject of controversy. Some authors advocate early probing and irrigation, whereas others recommend delaying until the child is at least one year old. The focus of this study was to compare the result of conservative treatment for CNLDO with the results of probing and irrigation of CNLDO undertaken for children between the ages of 6 and 24 months. A total of 128 patients [182 nasolacrimal ducts] with CNLDO were enrolled in a prospective clinical study at Prince Hashem Hospital in Zarka. Initially, all patients were treated conservatively with local hydrostatic massage and topical antibiotic drops. The patients were divided into four age groups. The first group was infants with CNLDO observed for spontaneous resolution during the second half of the first year. The other three groups were between the ages of 6 and 24 months with a 6-month interval between each group. Patients of these three groups underwent probing under brief general anesthesia. 77.1 percent of the infants exhibited spontaneous opening of the CNLDO during the second half of the year. Initial probing undertaken on infants between the ages of 6 and 12 months has been associated with the opening of the lacrimal ducts in 94.1 percent of cases, whereas, using the same procedure for children between the ages of 12 and 18months, the success rate was found to be 79.6 percent. Only 55.9 percent of obstructed nasolacrimal ducts were patent after probing in children between the ages of 18 and 24 months. indicate that probing carried out on infants with CNLDO between 6 and 12 months significantly reduces epiphora compared with waiting for spontaneous resolution in infants with the same conditions. At the same time it gave significantly better results compared to probing undertaken on older age groups

Diclofenac sodium for the treatment of ocular contusion with microhyphema

In this study, the effectiveness of topical diclofenac sodium has been investigated in the treatment of microhyphema. A total of 62 patients with traumatic microhyphema were enrolled in a prospective, randomized, double-masked, placebo-controlled clinical study. Of these, 32 were given diclofenac eye drops, while 30 received a placebo. All were observed daily until there was complete recovery. One drop of diclofenac sodium or a placebo was applied four times a day. The efficacy evaluation was based on the measurement of visual acuity, slit-lamp assessment of anterior chamber cells and flare and duration of treatment. Diclofenac sodium was statistically favored over the placebo in flare and cell score. The duration of treatment of the diclofenac group was significantly shorter than the placebo group. Visual acuity of diclofenac sodium recipients was significantly better than the placebo recipients from the third to the sixth day of treatment. No statistical difference in final visual acuity was found between the two groups [P>0.05]. The research indicated that diclofenac sodium reduces microhyphema effectively and more quickly than the placebo, leading to early rehabilitation of patients following ocular contusion