Monocanalicular silastic intubation for the initial correction of congenital nasolacrimal duct obstruction

BACKGROUND Treatment of persistent nasolacrimal duct (nasolacrimal duct obstruction) obstruction traditionally has consisted of simple probing. The most common complication with this approach has been recurrent obstruction, requiring another probing, often with the use of bicanalicular silastic intubation. Monocanalicular silastic tubing offers the possibility of increased success rates over simple probing while theoretically minimizing the insertion and removal difficulaties posed by bicanalicular techniques. We report, to our knowledge, the largest series to date of patients undergoing monocanalicular silastic intubation, as well as the first report evaluating this technique as the primary treatment for congenital nasolacrimal duct obstruction obstruction. METHODS This was a retrospective chart review of 635 children treated by 3 pediatric ophthalmologists via probing with monocanalicular silastic intubation as the initial procedure for congenital nasolacrimal duct obstruction obstruction. Success was defined as good clearance of fluorescein dye and/or the absence of symptomatic tearing. Failure was defined as recurrent symptomatic tearing or inadequate clearance of fluorescein dye, leading to the performance of a second tear duct operation. RESULTS We identified 635 children who underwent probing with monocanalicular intubation as the primary treatment for congenital nasolacrimal duct obstruction obstruction (mean age at time of probing 18 months). The overall success rate for the 803 eyes undergoing surgery was 96%. The success rate for treatment performed in infants younger than 24 months of age (684 eyes) was 97%, declining to 90% when surgery was performed in infants older than 24 months of age (119 eyes; p < 0.001). These success rates compare favorably to previous reports of primary probing without silastic intubation, especially in children older than 12 months at the time of the probing. The only complication in the current study was conjunctival-corneal abrasion, occurring in 2% of cases. CONCLUSIONS Probing with monocanalicular silastic intubation as the initial surgical procedure for patients with congenital nasolacrimal duct obstruction obstruction is associated with a very high success rate and low complication rate, especially when performed by the age of 24 months.