الفهرس 
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Abstract
Congenital nasolacrimal duct obstruction (CNLDO) is a common disease in the early childhood period. It occurs in about 20 % of all newborns due to presence of a membrane at the valve of Hasner and it is self–resolving by the age of one year. Hydrostatic massage over the lacrimal sac and usage of topical antibiotics are standard management in the first few months. Probing can be done around the age of one year. If the disease persists after the first year of life, the most common procedures for management of the disease are probing and intubation. Many surgeons perform probing as the primary procedure for CNLDO. Others do intubation as a primary procedure in older children or for cases that probing has failed. Success rates of probing and intubation are matter of controversy.
The aim of this study is to compare between the successes of probing only versus probing followed by silicon intubation in the treatment of congenital nasolacrimal duct obstruction between different age groups from 2 to 4 years. This study also aims to know the effect of positive regurgitation test on success of probing and intubation and to know improvement of symptoms of probing and intubation during follow up visits.
This was a prospective study that was conducted on 34 children (40 eyes) with congenital nasolacrimal duct obstruction presented to outpatient clinic of Menofia University Eye Hospital and Tanta Ophthalmology Hospital from September 2016 to August 2017.
In this study, there were 14 males (41%) and 20 females (59%) of 40 eyes. There were 28 children (82%) with unilateral CNLDO and 6 children (28%) with bilateral disease.
The patients were divided into 2 groups:
group 1 was treated by Probing under general anesthesia.
There were 16 children; 8 males (50%) and 8 females (50%). The right eye was affected in 4 (25%) and the left eye in 8 (50%) and bilateral in 4 (25%) cases.
group 2 was treated by Probing followed by silicon intubation under general anesthesia.
There were 18 children; 6 males (34%) and 12 females (66%). The right eye was affected in 9 (50%) and the left eye in 7 (39%) and bilateral in 2 (11%) cases.
All patients were followed up after one week, one month then three months post-operatively and the success of probing and intubation was defined as complete resolution of symptoms and signs of nasolacrimal duct obstruction.
The results of this study showed that:
- Success rate of intubation (80%) was higher than probing (60%) and this difference was statistically significant.
- The difference in success of probing between different age groups between 2 to 4 years was statistically significant, so increasing age decreased the success rate of probing.
- Success rate in cases of intubation decreased with increasing age. However, the differences were statistically insignificant.
- Success rate in cases of intubation was higher than probing in different age groups but the changes were statistically significant in age ranging from 37-48 months.
- Positive regurgitation test decreased the success rate of both probing and intubation but changes were statistically significant in probing (P=0.008*).
Conclusions
The current study shows that probing and intubation of the NLD are standard therapeutic procedures in the management of CNLDO. Although the success rate of intubation is higher than probing in different age groups, the result of probing is high and reliable from 24-36 months. The difference between them is statistically significant from 37-48 months. The success rate of probing decreases with increasing age and positive regurgitation test significantly.