Intranasal Endoscopic Diagnosis and Treatment in Congenital Nasolacrimal Duct Obstruction

ABSTRACT

This study is to demonstrate the effectiveness of intranasal endoscopy during silicone tube insertion in children with congenital nasolacrimal duct obstruction. Participants were 10 children with symptoms of epiphora since birth. They underwent silicone tube insertion during the period of July 1998 to November 1999. Three were female and seven male. Mean age was 25.8 months, ranging from 15 to 44 months. Probing had been failed in five of them, once in two children and twice in the other three. Silicone tube insertion was done after identifying the cause of probing failure by observing the probe tip with intranasal endoscopy. The cause of tearing confirmed by intranasal endoscopic examination were mucosal obstruction in 5 cases, submucosal passing of the probe in 4 cases and obstruction due to pus collection in one case. In 4 cases in which the probe had passed into submucosal space, probing succeeded in three cases by placing the probe tip medially(nasal direction). There was accompanying abnormal bony structure in the other one case and we had to bend the probe tip with ethmoid forceps into nasal cavity to form the lacrimal pathway. When probing fails or is difficult to do due to poor cooperation, identifying the cause of failure with intranasal endoscopic examination and inserting silicone tube under direct visualization can minimize intranasal trauma and will lead to good outcome.