EYcacy of probing as treatment of epiphora in adults with blocked nasolacrimal ducts

Aims—To determine the eYcacy of probing in the initial treatment of epiphora and the symptom free period in adults with blocked nasolacrimal ducts. Methods—The results of probing in 85 eyes with epiphora due to nasolacrimal duct obstruction were studied retrospectively after a mean follow up of 7.4 months (SD 11.6) by a questionnaire and interview survey of patients. Results—35% of the eyes had an outcome of no watering after probing, 17% mild watering, 35% moderate watering, and 11% severe watering. The patients’ satisfaction (watering subjectively improved) after undergoing this procedure was 82%, which is higher than previously reported. The mean symptom free period in eyes with no watering was 11.25 months, in eyes with mild watering 8.20 months, in eyes with moderate watering 5.35 months, and in eyes with severe watering 0.95 months. There was a significant diVerence (p=0.001) in the symptom free period between the no watering and severe watering groups. Conclusions—Probing in adults with confirmed nasolacrimal duct obstruction can be recommended as an initial treatment procedure because of its relatively good eYcacy and high patient satisfaction without compromising subsequent surgical treatment if unsuccessful. (Br J Ophthalmol 1998;82:389–391) Idiopathic or primary acquired nasolacrimal duct obstruction (NLDO) is a syndrome of unknown aetiology and accounts for the majority of NLDO found in adults. It is postulated that inflammation of unknown cause results in possible occlusive fibrosis of the nasolacrimal system (NLS) causing obstruction and subsequent epiphora 4 or “watering eye”. Studies in children below the age of 4 months show that probing is an eVective treatment. However, the risk of failure from probing increases with age, doubling every 6 months. To our knowledge, only one published study has investigated the eYcacy of probing as a method for treating epiphora in adults. The authors of that study reported a 52% success rate measured by subjective improvement in watering after probing. Probing in adults is quick, safe, easily performed with local anaesthesia, cost eVective, and potentially an outpatient procedure. Probing as an initial procedure for adult epiphora has been carried out in this institution for the past 7 years providing the opportunity for the analysis of its eYcacy by a survey of the probed patients. Methods In this retrospective study, adult patients aged 18 or older, of either sex who had probing for epiphora from January 1992 to November 1996 were selected. All probing were carried out by ophthalmologists at the consultant level. Patients were excluded if they had epiphora present from birth (congenital abnormality of NLS), 8 watering secondary to a herpetic canaliculitis, dacryocystitis, and lacrimal sac mucocele. 9 10 Patients with previous trauma, surgical intervention, intranasal disease, neoplasm of the lacrimal sac, 11 corneal ulcer or foreign body, and any overproduction of tears (that is, any condition that causes reflex stimulation of the ophthalmic division of the trigeminal area) were excluded. Patients with abnormal punctal apposition, ectropion, and those with minimal symptoms (watering outdoors, only in cold wind that may occur in individuals with normal lacrimal excretory system) were also excluded. 9–14 Of the 108 eyes identified in the study period, eight eyes did not meet the study criteria and were excluded. Of these eyes, five had dacryocystitis and two had unsatisfactory probing on the operating table (characterised by diYculty in passing the probe and subsequent inability to irrigate saline through the NLS to the nose) and one patient had died (see Table 2). From the 100 eyes which met the criteria, 15 eyes with an unknown outcome belonging to 11 patients (four patients with bilateral and seven patients with unilateral NLDO) were also excluded. This study is based on the remaining 85 eyes (41 right NLS and 44 left NLS) from 65 patients; 45 patients had unilateral and 20 patients had bilateral NLDO. All patients had symptomatic epiphora and blockage of the lacrimal system confirmed on syringing. The mean age of the patients was 64.1 (SD 15.5, range 19–89) years. There were 38 females and 27 males. Table 1 summaries the demographic data. Probing was carried out with a Foster’s probe usually size 0.8 and through the upper canaliculus. We used the anaesthetic amethocaine drops to the conjunctival sac and lignocaine 2% and adrenaline infiltration around the medial canthus, the lower lid and deep up to the periosteum. The probe was advanced to the point of obstruction and pushed through with a gentle pressure. Patency following the probing was confirmed by syringing. Patients were treated with topical chloramphenicol, Br J Ophthalmol 1998;82:389–391 389 Department of Ophthalmology, Darlington Memorial Hospital, Darlington, County Durham DL3 6HX