Congenital lacrimal obstruction

The lacrimal drainage system begins to develop during pregnancy as stripes of tissue (they are not hollow) and their lumen begins to form later on. Sometimes their development is not complete at birth and continues in the first months of life. In more than 75% the nasolacrimal duct is affected. The lacrimal obstruction manifests in approximately 6% of newborns as secretion from the eye, epiphora or combination of these symptoms. Less frequently it manifests as amniocoele – bluish painless swelling of the lacrimal sac visible immediately after birth. This may develop into the acute inflammation of the lacrimal sac (acute dacryocystitis) with its painful oedema and redness, often together with fever and general health alteration. The first step of the treatment is conservative with application of eye drops (disinfecting or/and antibiotic) together with pressure massage of the lacrimal sac. Up to 80% of congenital lacrimal obstruction resolves spontaneously in 4 to 6 months after birth, therefore it is suitable to treat it conservatively up to this age. However if the symptoms remain, nasolacrimal duct probing with Bowman probe is indicated and is performed in local anaesthesia on outpatient basis with success rate of approximately 85%. If the first probing fails it is possible to repeat it on outpatient basis in one month with success rate of 70%. If even the repeated probing fails to resolve the symptoms, stenting of the lacrimal pathways with a silicone cannula (intubation) is indicated and is performed under general anaesthesia. The cannula acts as a so called stent – it keeps the drainage system open during the healing but does not ensure the drainage itself. It is possible to introduce the cannula through one lacrimal canaliculus (monocanalicular intubation, Fig. 1, 2) or through both canaliculi (bicanalicular intubation, Fig. 3, 4). The cannula is removed in 3 months on outpatient basis with succes rate of approximately 96 %. If the nasolacrimal duct is not developed or it is impossible to unblock it, in condition that the lacrimal canaliculi and lacrimal sac are patent, dacryocystorhinostomy (DCR) is indicated (See Lacrimal Disorders – Lacrimal sac and nasolacrimal duct disorders). In case of complete canalicular obstruction conjunctivodacryocystorhinostomy is performed after the 10th year of age of the child (See Lacrimal Disorders – Disorders of the lacrimal canaliculi).

Fig. 1 Monocanalicular intubation through the lower lacrimal canaliculus.

Fig. 2 The right eye, monocanalicular intubation through the lower lacrimal canaliculus.

Fig. 3 Bicanalicular intubation.

Fig.4 The right eye, bicanalicular intubation.

Zarovnání
clear

The number of our pediatric patients with congenital lacrimal obstruction, diagnosed and treated both conservatively and surgically, is one of the highest not only in the Czech Republic, but also in international context. Our results are continuously evaluated and presented as articles in scientific journals and presentations at both national and international congresses (See S. Červenka, M.D., Ph.D. – Publications).