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  • Crigler lacrimal sac compression yields favorable outcomes for cases of CNLDO

    Oculoplastics/Orbit, Pediatric Ophth/Strabismus

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    Review of: Congenital nasolacrimal duct obstruction update study (CUP study): paper I—role and outcomes of Crigler’s lacrimal sac compression

    Bansal O, Bothra N, Sharma A, et al. Eye, June 2021

    This retrospective, interventional case series evaluated the role and outcomes of Crigler lacrimal sac compression (CLSC) in the management of congenital nasolacrimal duct obstruction (CNLDO).

    Study design

    The study included 1,240 patients with CNLDO. Patients who received Crigler lacrimal sac compression (CLSC) were divided into 4 groups according the age when CLSC was initiated: 0 to 3 months (group 1), 3 to 6 months (group 2), 6 to 9 months (group 3), and 9 to 12 months (group 4). Cases in which CLSC was performed incorrectly were assessed separately. Researchers followed patients quarterly and assessed resolution of CNLDO.

    Outcomes

    In I,037 of the patient cases CLSC was performed correctly and in 203 cases incorrectly. Among patients who received the correct procedure, resolution of CNLDO was achieved in 87%, 79%, 78%, and 77% of patients in age groups 1 to 4, respectively. In the group performing compression incorrectly, 61% achieved resolution.

    Limitations

    The overall rate of resolution was 81%, which is significantly lower than other large studies in which the resolution rates were as high as 96%. There could be a bias toward more complex obstruction in the authors' referral population compared with a community setting, potentially making it difficult to extrapolate these conclusions to a community setting.

    Clinical significance

    Crigler lacrimal sac compression appears to influence resolution outcomes. However, the age at which compression is initiated does not substantially affect outcomes, with patients achieving significantly high resolution even if treatment was initiated after 9 months of age. Clinicians should adopt this maneuver for all patients with CNLDO and instruct families on how to correctly perform the massage.