الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Epiphora is defined as an overflow of tears in the presence of normal tear production, produced due to either obstruction in the drainage apparatus, i.e., puncta, canaliculi, sac or nasolacrimal duct or improper tear drainage.
At birth in up to 30% of infants the lacrimal drainage is not patent in, but only 5% to 6% of them complain from symptoms of lacrimal outflow obstruction. The condition resolves spontaneously in about 70% of the patients by the age of 6 months, and 80% to 90% will exhibit patency by the age of 12 months. After the age of 1year the cure rate will become increasingly uncommon.
Gentle pressure applied medially to the lacrimal sac transmits hydrostatic force through the nasolacrimal duct to the membranous obstruction. When performed properly, this massage technique can perforate the obstruction and relieve the blockage immediately. Three to five squeezes are usually sufficient daily till the age of one year.
If lacrimal massage fails to open the nasolacrimal duct with persistence of epiphora, the patient should undergo NLD probing also probing is indicated for all acquired cases above the age of 12 months and for all patients presented by epiphora post traumatic.
If the repeated probing doesn’t proceed easily or fails, silicone intubation of the nasolacrimal duct or DCR will be indicated.
DCR is usually reserved for children who have persistent epiphora following silicone intubation or for patients with extensive developmental abnormalities of the nasolacrimal drainage system that prevent probing or silicone intubation.
The aim of the work was to identify the pattern of cases presenting with pediatric epiphora, management protocol and its outcome of patients referred to the pediatric outpatient clinic of Alexandria main university hospital and the efficacy of patients’ management essential to plan resources required for ideal patients’ management.
In the current study 184 children (255 eyes) attending AMUH for watery eye. They were classified according to etiology into congenital and acquired.
Congenital cases were 209 (82.0%) were of CNLDO while there were 21 eyes (8.2%) were of Down patients. Primary acquired cases were 16(6.3%) while secondary acquired were 9 eyes (3.5%) were presented with a history of trauma to the lacrimal drainge system.
Lacrimal massage 5 times daily and local antibiotic eye drops if there were significant secretions were applied to congenital cases with success of 52.50%.
Probing of the NLD is a standard therapeutic procedure in the management of the CNLDO. However, the outcome of probing in children older than 1year has a great variability.