# Epiphora associated with anomalies of the distal end of the nasolacrimal duct in children over 12 months: endoscopic findings and treatment

## TL;DR

This study examines endoscopic findings and treatment outcomes for children over 12 months with congenital tear duct issues.

## Contribution

The study identifies four types of distal nasolacrimal duct obstructions and shows effective treatment without silicone intubation.

## Key findings

- Four types of distal nasolacrimal duct obstruction were diagnosed in children.
- Endoscopic microsurgery achieved successful outcomes in all cases without silicone intubation.
- The mean follow-up period showed no complications from the treatment method.

## Abstract

Congenital epiphora can be related to anomalies of the nasolacrimal duct.
This study aimed to assess the distal end of the nasolacrimal duct and the
outcomes of endoscopic treatment in children older than 12 months with
congenital epiphora.

This retrospective analysis describes the clinical characteristics,
management, and outcomes of symptomatic congenital lacrimal obstruction in
32 lacrimal systems of 23 children. Data was collected on the preoperative
symptoms, age at the time of surgery, intraoperative findings, treatment
modalities, and outcomes of the children in our cohort. All patients
underwent a standard endoscopic lacrimal examination, including irrigation
and diagnostic probing, viewed via the inferior meatus. Cases with complex
anomalies characterized by obstructions in the canaliculi, nasolacrimal
junction, or nasolacrimal duct were excluded.

The mean age at the time of surgery was 48.03 (±27.99) months. Four
different types of distal nasolacrimal duct obstruction were diagnosed.
These were obstructions by a membrane (n=12), ostium stenosis (n=15),
impacted turbinate (n=3), and membranous residual flaps (n=2). They were all
managed with inferior meatus microsurgery and nasal endoscopic probing
without silicone intubation. After a mean follow-up period of 14.75
(±11.93) months, successful outcomes were achieved in all cases.

Microsurgery to the inferior meatus, performed under nasal endoscopy, is a
safe and effective treatment for isolated anomalies of the distal end of the
nasolacrimal duct in children older than 12 months. We do not recommend
silicone intubation in the absence of complex lacrimal system anomalies.