Congenital nasolacrimal duct obstruction: Should we continue lacrimal massage till 1 year or perform an office probing at 6 months? A clinical decision analysis approach

Congenital nasolacrimal duct obstruction: Should we continue lacrimal massage till 1 year or perform an office probing at 6 months? A clinical decision analysis approach Sir, We read the study by Bhandari et al. [1] with interest. It was of particular interest to us because probing for the congenital nasolacrimal duct obstruction (CNLDO) remains the second most common ocular surgical intervention in pediatric ophthalmology clinics and it is of interest to all the ophthalmologists and pediatricians. The CNLDO affects as many as 20% children aged <1 year worldwide. A failure rate of 70% with lacrimal massage as reported by the authors [1] and the increase in the failure rate of probing by 25% for every 6 months delay bring us to a question whether is it better to wait for probing for approximately a year or year and a half (as practiced today) or perform a probing early at 6 months age. Other disadvantages of delaying the probing could be more medical visits, longer duration of persistent symptoms, and a compulsion to give general anesthesia if probing is needed later. The idea of performing an " office probing " is especially attractive when we consider the reported success rate of 75% by the Pediatric Eye Disease Investigator Group (PEDIG) [3] and the ease with which it can be performed by restraining the child without the need of general anesthesia. Moreover, a failed office probing would not increase the failure rate of repeat probing later if the need be. To answer the question whether we should advise an early office probing (at 6–9 months) versus a delayed conventional probing (at 12–15 months) in children with CNLDO, we reviewed the study published by the authors, [1] compared similar data from our center and used the data from the study on office probing published by PEDIG [Table 1] using a clinical decision analysis approach that was previously published in this journal. [4] The reason we had to separately create the decision tree using our (urban) data was because our patients were from higher socioeconomic strata and presented at an earlier age in contrast to that in the study by Bhandari et al. The physical health of the patients from different socioeconomic strata could affect their respiratory status and the compliance to treatment and a late age of presentation also negatively affects the outcome of the treatment of the CNLDO. When we applied the …