Monocanalicular versus bicanalicular endoscopic assisted Ritleng intubation for treatment of congenital NLD obstruction

Objective: To compare the results and complications of monocanalicular and bicanalicular Ritleng intubation under endoscopic guidance in patients with congenital nasolacrimal duct obstruction. Methods: This prospective study was performed on 24 patients with congenital NLD obstruction in the age between (2-5 years), divided into 2 groups. Group (A) underwent monocanalicular intubation, while group (B) underwent bicanalicular intubation. Results: 11 patients out of 12 were free of symptoms and signs in each group with equal success rate in each group (91.6%). However, more complications occurred with bicanalicular Ritleng intubation as stent displacement and punctual laceration. No unplanned silicon tube removal was needed. Corneal erosion and granuloma formation were not reported in either group. Conclusion: Monocanalicular Ritleng intubation seems to be as effective as bicanalicular intubation for treatment of congenital NLD obstruction, but monocanalicular intubation seems to be safer, easier, shorter procedure with less complications. Introduction Congenital nasolacrimal duct obstruction (CNLDO) is a common problem in children, occurring in 6% or more of all newborn infants [1,2]. The usual cause is failure of canalization of the epithelial cells that form the nasolacrimal duct as it enters the valve of Hasner [3]. Spontaneous resolution occurs in 80-96% of affected infants [1,34]. Within the first few months of life, standard management of CNLDO includes hydrostatic massage of the lacrimal sac and use of topical antibiotics. An equally satisfactory approach is conservative management up to 9-12 months of age awaiting spontaneous resolution [5], followed by hospitalbased probing for persistent obstruction. Although it is unclear whether probing is less successful when delayed either by choice or by late presentation, most studies have concluded that the success rate of probing decreases with age. Probing could be less successful in older children perhaps because of prolonged inflammation of nasolacrimal system resulting in scarring and more severe obstructions with time [5,6-7]. Silicone intubation is a simple procedure, and a variety of instruments and modifications of technique have been devised [8,9]. The Ritleng lacrimal intubation system provides a technique for mono and bicanalicular silicone intubation without the need for the retrieval of metal probes from the inferior meatus. Recent advances in technological progress in rigid endonasal probes have increased interest in endoscopically transnasal interventions for CNLDO. Endoscopically assisted procedures also allow further nasal interventions during the procedure, with decreased surgical time [10]. Correspondence to: Dr. Walid M Abdalla, MD, FRCS, Eye Consultants Center FZ-LLC, Dubai, United Arab Emirates; E-mail: [email protected]