Insights into Treatment Approaches for Congenital Tear Duct Obstruction in Children

Excessive tearing in infants and young children often stems from congenital tear duct obstruction, the most common cause of the condition. While most cases require minimal treatment, a recent study conducted by the Boston Children's Department of Ophthalmology, analyzing over 19,000 patient records from across the U.S., sheds light on the outcomes of different treatment approaches.

The study indicates that children who undergo treatment in a surgical setting have a slightly better chance of not requiring further care. However, the findings also reveal that basic office-based treatments may pose a slightly higher risk of repeated procedures.

Lead author of the study, Dr. Isdin Oke, MD, MPH, emphasizes the importance of these findings in guiding meaningful conversations between clinicians and families when deciding on the appropriate treatment approach.

Nasolacrimal duct obstruction (NLDO), resulting from a narrow tear duct, can lead to tearing, irritation, and increased susceptibility to eye infections in affected children. While most children's NLDO clears naturally over time, some require medical intervention. The study, which drew on the American Academy of Ophthalmology's Intelligent Research in Sight (IRIS) registry, aimed to identify whether the type and location of treatment influence the need for additional care after an initial procedure.

Published in JAMA Ophthalmology, the study highlights that one in 14 patients had additional treatment within two years of their first procedure. Factors contributing to the need for further care were identified, providing insights that could help prevent repeat procedures.

Notably, the study found that the highest risk of recurring NLDO was associated with "simple" probing conducted in a clinician's office. However, despite this risk, nine out of 10 patients who underwent this in-office treatment did not experience recurring NLDO. Lower risk was associated with patients who had obstruction cleared by dilation of the tear duct or placement of a silicone tube, both performed under anesthesia by surgeons with a high volume of NLDO procedures.

Dr. David G. Hunter, MD, Ph.D., chief of the ophthalmology department and one of the study's authors, suggests that while the findings do not significantly favor one treatment option, healthcare providers can consider the data to determine the best approach for their patients.

The study's recommendations include prescribing antibiotics as needed, considering surgical treatment if the condition persists, particularly for infants, and acknowledging that treatment decisions may ultimately depend on parental preferences.

Reference

Isdin Oke et al, Factors Associated With Nasolacrimal Duct Probing Failure Among Children in the Intelligent Research in Sight Registry, JAMA Ophthalmology (2023). DOI: 10.1001/jamaophthalmol.2023.0004