Several surgeries may be needed to treat CNLDO in children with Down syndrome

Congenital nasolacrimal duct obstruction (CNLDO) is often seen in children with Down syndrome, but is harder to treat in this patient population.

Study design

This was a retrospective chart review of 126 children with Down syndrome (mean age 1.8 years) who were diagnosed with congenital nasolacrimal duct obstruction (CNLDO) at Children’s Hospital of Philadelphia. Outcome measures included the types and number of surgical interventions, outcome of surgical intervention, and overall success rate.

Outcomes

Eighty-four patients underwent surgical intervention, 32 of whom underwent at least one additional procedure (mean 1.8 surgical interventions). Initial probing was successful in 59% of patients. Patients who underwent stenting of the lacrimal system had a significantly higher success rate compared with patients who underwent probing alone. The probability of undergoing multiple procedures increased with the number of interventions. Patients with bilateral CNLDO were more likely to undergo at least one intervention than patients with unilateral CNLDO. Nearly all patients achieved complete resolution.

Limitations

The study is limited by its retrospective design and also the likely bias of being a single-center study at a tertiary-care children’s hospital.

Clinical significance

The incidence of CNLDO in patients with Down syndrome is approximately 30% and is more commonly bilateral rather than unilateral. This study demonstrates that a lower initial success rate of probing was seen in this population of patients than has been reported in studies of non-syndromic CNLDO; therefore, stenting of the lacrimal system may be a more appropriate primary intervention. Although the final success rate is high, the likelihood of multiple procedures is increased in children with Down syndrome. These issues should be discussed with their parents or guardians.

Financial Disclosures: Dr. Richard Allen discloses no financial relationships.