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Timing of intervention for unresolved congenital nasolacrimal duct obstruction

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Clinical Question

When is the optimal time to intervene with probing for unresolved congenital nasolacrimal duct obstruction?

Bottom line

The rate of spontaneous resolution of congenital nasolacrimal duct obstruction (CNLDO) is highest in the first 4 months to 6 months of age, with plateauing of resolution after 9 months of age. Surgical probing appears to be optimal at approximately 12 months of age, after the CNLDO has had time to resolve on its own but before surgical success rates begin to decline (after age 15 months). 1b

Reference

Sathiamoorthi S, Frank RD, Mohney BG. Spontaneous resolution and timing of intervention in congenital nasolacrimal duct obstruction. JAMA Ophthalmol 2018;136(11):1281-1286.

Study design: Cohort (prospective)

Funding: Foundation

Setting: Outpatient (specialty)

Synopsis

CNLDO is common, occurring in approximately 1 in 9 newborns. These investigators reviewed medical records of 1998 consecutive children, younger than 5 years, who were given a diagnosis of CNLDO while residing in Olmsted County, Minnesota, from January 1, 1995, through December 31, 2004. Among these children, CNLDO spontaneously resolved in 83.5%, with 14.5% requiring surgical treatment and 2.0% lost to follow-up. The median age at resolution was 2.4 months, with the rate of spontaneous resolution highest in the first few months of life and declining until age 9 months when the rate of resolution reached a plateau. Of the patients who underwent surgical intervention with probing, children aged 15 months or older had a decreased odds of resolution compared with children aged 12 to 14 months (odds ratio 0.11; 95% CI 0.01 - 0.89). No difference in probing success rate occurred, however, when patients younger than 9 months and aged 9 to 11 months were compared with patients aged 12 to 14 months.

Reviewer

David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC

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