Szemészet, 2012 (149. évfolyam, 1-4. szám)

2012-03-01 / 1. szám

dacryocystitis and purulent discharge. Probing with irrigation at the age of 3 had failed. She had dilated inferior lacrimal puncta with excess tearing. There was no sign of acute inflammation. Rhinological examination showed enlarged conchae without septum deviation. Endonasal surgical intervention was not considered to be necessary Endocanalicular endoscopy was performed under general anesthesia. Following local application of Xylometazoline eye drops to the conjunctiva, the right upper punctum was dilated first and the endoscope was inserted into the upper canaliculus. The endoscope was carefully pushed into the lacrimal sac. Intraoperative findings revealed a mucous blockage of the nasolacrimal duct (Fig.l). The obstruction was opened with the microdrill (Fig. 2). During the procedure, the sac was constantly dilated by an infusion of 0.9% saline solution through the endoscope channel. The same procedure was performed on each side. Both sides were intubated with a silicone tube. The postoperative care consisted of antibiotic and astringent eye drops and nasal drops 3 times a day for

2 weeks. The child was admitted into the pediatric ward for postoperative care for 2 days. At discharge, there was no swelling, no inflammation and both tubes were in position.

The right silicone tube became dislocated after 4 weeks and it was tightened by an ENT-surgeon in an ambulant set-up. In view of the tension on the punctum this tube had to be removed the following week under general anesthesia. The silicone tube of the left side stayed in position for

3 months, as planned. Ten months after surgery the girl is doing very well and has had no epiphora or infections since the tubes were removed (Fig. 3).

Discussion

Uncomplicated congenital nasolacrimal obstructions are reported in the literature in approximately 20% of neonates. Spontaneous resolution occurs in up to 96% in the first year (2). In the first few months of life, a congenital nasolacrimal obstruction can be effectively treated with antibiotic eye drops, astringent eye and nasal drops while massaging the lacrimal sac 3 times a day if there is no additional complication such as mucocele or inflammation (3). Probing and syringing can cure the majority of cases. Acute dacryocystitis can turn into chronic disease in 30% of cases (4).

The nasal anatomy in children with narrow airways, enlarged conchae, bulky inferior turbinate and deviation of the nasal septum can make endonasal access a challenge. To our knowledge, this is the first reported case of a transcanalicular dacryoplasty using a microdrill in a child. Lacrimal endoscopy is usually performed with a microendoscope of 500 ц,m, 700 /лт or 900 fxm in children (5). flowever,

Fig. 3. Cosmetic and functional results 10 months after surgery