Treatment of epiphora in infants

Purpose: To discuss the reasons of epiphora in infants and the natural history, treatment of lacrimal drainage system obstruction. In excluded excessive tear production epiphora means watery eyes in drainage failure. All parts of the lacrimal passages can be obstructed or anomalous, including lid malposition, skeletal, sinus malformation. Methods: Clinical practice with retrospective interventional case series in children (0-60 months) with epiphora. Descriptive analysis of a five year period, over 500 children. Complete resolution of symptoms counted as a patent tear outlow system. Results: Systemic associations were rare, a few children with Down sydrome had nasolacrimal duct obstruction. Only 7 of over 500 children who had undergone lacrimal duct probing needed dacryocystorhinostomy and intubation. All these children have presented recurrent dacryocystitis without orbital celulitis. The microbial profile of the positive cultures consisted of Gram-positive and or Gram- negative bacteria, mostly of Staph. aureus, Str. pneumoniae, Haemophilus influenzae, all sensitive to chloramphenicol and ofloxacin and to at least 5 other out of 8-10 tested antibiotics. No complications of probing or surgery were seen. Conclusions: Probing and irrigation of lacrimal ducts is highly effective, safe and simple procedure even after the first year of age, though so far not determined whether probing really shortens the duration of epiphora. Spontaneous improvement is possible at any age. On the other hand early probing in dacryocystocele can reduce the incidence of dacryocystitis.