Balloon Dacryocystoplasty as the Primary Treatment in Older Children with Congenital Nasolacrimal Duct Obstruction

Purpose: To report the outcomes of balloon dacryocystoplasty of the lacrimal duct with inferior turbinate infracture as a primary treatment of congenital nasolacrimal duct obstruction in children 18 months of age or older. Materials and methods: This study was a 3-year, prospective, interventional case series, consisting of 83 consecutive patients with congenital nasolacrimal duct obstruction who underwent balloon dacryocystoplasty as their primary treatment modality. Outcome evaluations included an ophthalmologic examination and a dye disappearance test at 3 weeks and 6 months postoperatively. We analyzed the different age groups and the types of obstruction noted at surgery to determine their respective influences on patient outcomes. We used the chi-square test for statistical analysis. Results: Seventy-two patients aged 18 to 112 months (mean 30 months) were included. Overall, 57 patients (79%) had good outcomes from balloon dacryocystoplasty. When analyzed by type of obstruction, 34/42 patients (81%) with simple membranous obstruction at the valve of Hasner had good outcomes and 23/30 patients (77%) with stenosis that extended along the length of the distal NLD had good outcomes (P = 0.60, power 0.62). Age did not significantly affect outcomes (P = 0.66, power 0.72). Conclusions: Balloon dacryocystoplasty is probably more effective than simple probing in older children with stenosis extending along the distal nasolacrimal duct obstruction.