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  • Optimal Time to Intervene for Nasolacrimal Duct Obstruction

    By Lynda Seminara
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, November 2018

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    Congenital nasolacrimal duct obstruc­tion occurs in 1 of 9 newborns and will spontaneously resolve in most. How­ever, 25% of affected children require mechanical probing of the duct. Some investigators have proposed delaying such treatment until the child is about 1 year old. In a retrospective review, Sathiamoorthi et al. aimed to define the optimal time to probe nasolacrimal duct obstructions. They noted that spontaneous resolution appeared to plateau after 9 months of age, where­as the success rate for initial probing declined after 15 months of age. Hence, the ideal window for successful surgical intervention may be earlier and smaller than that used in clinical practice.

    The study cohort comprised 1,998 infants in Olmstead County, Minnesota, who received follow-up for 10 years after diagnosis. The median age at di­agnosis was 1.2 months. All told, 1,669 of the infants experienced spontaneous resolution, 289 required surgical inter­vention, and 40 were lost to follow-up. The rate of resolution was 35% faster at <1 month than at 3 months of age, 43% faster at 3 months than at 6 months, 39% faster at 6 months than at 9 months, and 1% slower at 9 months than at 12 months. Probing after 15 months of age was linked to lower likelihood of success. Success rates for initial probing, by ascending age group, were 90.2% (6-12 months), 83.1% (12-18 months), 71.4% (18-24 months), and 64.7% (24+ months).

    Most earlier studies showing spontaneous resolution in >90% of con­servatively treated infants involved fewer than 200 patients, with associated biases that may have skewed results. In this study, the authors corroborated the tendency for congenital nasolacrimal duct obstructions to resolve without surgical treatment, and they affirmed that the rate of spontaneous resolution declines with age and eventually pla­teaus. A narrower-than-typical time frame for intervention (between 9 and 15 months of age) may capitalize on variations in resolution and the de­clining success rate for initial probing. (Also see related commentary by Michael X. Repka, MD, MBA, in the same issue.)

    The original article can be found here.