Skip to main content
  • Oculoplastics/Orbit, Pediatric Ophth/Strabismus

    Review of: Factors associated with nasolacrimal duct probing failure among children in the Intelligent Research in Sight Registry

    Oke I, Elze T, Miller J, et al. JAMA Ophthalmology, in press 2023

    An assessment of IRIS Registry data focused on risk factors for repeat probing procedures to manage congenital nasolacrimal duct obstruction in young children.

    Study design

    This was a retrospective cohort study of 19,357 children in the IRIS Registry who underwent nasolacrimal duct probing before age 4 between 2013 and 2020. Children having a history of prior canalicular repair and those with missing laterality were excluded. Both office- and facility-based probing, silicone intubation, and balloon catheter dilation were searched via the respective CPT codes. Treatment failure was defined as identification of a subsequent procedure performed on the same side within 2 years of the first procedure during the study period.


    Multivariable analysis revealed that a higher risk of reoperation was associated with bilateral vs unilateral nasolacrimal duct obstruction and office- vs facility-based simple probing. Lower risk of reoperation was linked to primary balloon catheter dilation vs facility-based simple probing and procedures performed by high- vs low-volume surgeons (high-volume was defined as performing ≥20 nasolacrimal probing procedures each year on average during the study interval). All other studied variables such as age, sex, race, ethnicity, geographic region, and operative side were not associated with a risk of repeated procedures.


    The generalizability of the results is limited due to the fact that certain geographic regions and racial and ethnic groups may be underrepresented in the IRIS Registry. Selection bias is of concern, as not all practices participate in the IRIS Registry and this may contribute to an underestimation of failure rate. The study assumed that the first procedure was performed within the study interval and did not account for instances when the patient had their primary procedure performed at a practice outside of the IRIS Registry or outside the study interval, thereby overestimating the reduction in failure rate associated with silicone intubation and balloon catheter dilation. The definition of failure may have underestimated clinical failure in those cases in which a decision was made not to perform any additional intervention or when the patient left the IRIS Registry.

    Clinical significance

    Both office- and facility-based simple probing procedures play an important role in the management of congenital nasolacrimal duct obstruction in infants, and the options merit discussion between the physician and family. Children with congenital nasolacrimal duct obstruction undergoing probing at an older age may be more likely to have unusual pathology that may put them at greater risk of recurrence, thus justifying starting with a more complex procedure such as balloon catheter dilation or silicone intubation.

    Financial Disclosures: Dr. Nikisha Richards discloses no financial relationships.