Immediate probing appears cost effective for unilateral NLDO

This study found that treating infants with unilateral nasolacrimal duct obstruction (NLDO) with immediate probing in the physician's office is likely more cost effective than observation followed by deferred facility probing for unresolved cases. According to the study's results, adoption of the immediate office-probing approach would result in probing in approximately two-thirds of infants whose obstruction would have resolved within six months of nonsurgical management but would largely avoid the need for probing under general anesthesia.

The study included 163 infants aged six months to less than 10 months with unilateral NLDO randomized to immediate office-based nasolacrimal duct probing or six months of observation/nonsurgical management followed by probing in a facility for persistent symptoms. Success was based on masked examination at age 18 months. Cost of treatment between randomization and age 18 months included costs for all surgical procedures and medications.

In the observation/deferred facility-probing group, NLDO resolved within six months without surgery in 66 percent of those who completed the six-month visit. Twenty-two (27 percent) of the 81 patients in the observation/deferred facility probing group underwent surgery, four of whom were operated on within the initial six months. At age 18 months, 92 percent of those in the immediate office-probing group were treatment successes, compared with 82 percent in the observation/deferred facility-probing group.

The mean cost of treatment was $562 in the immediate office probing group compared with $701 in the observation/ deferred facility-probing group. The immediate office-probing group experienced a mean of three fewer months of symptoms.

Despite the substantial difference in the cost of probing in an office setting versus a surgical facility, the difference between the cost of immediate office-probing versus observation/deferred facility-probing was small from a population perspective, primarily because only 27 percent of patients assigned to the latter approach underwent the more costly surgery in a facility.

The authors say that although their results are not statistically significant, they suggest that the immediate office-probing approach is likely to be at least as successful as the observation/deferred facility-probing approach and slightly less costly. They conclude that while unilateral NLDO often resolves without surgery, immediate office probing is an effective and potentially cost-saving treatment option.