Modified laser DCR for paediatric nasolacrimal duct obstruction

Aims To evaluate the efficacy, safety, and long-term outcome of modified laser dacryocystorhinostomy (DCR) for primary nasolacrimal duct obstruction, unresponsive to probing. Methods Retrospective, noncomparative case-note review of all paediatric cases operated between September 2000 and November 2003. Procedure A fibre optic light, inserted through the canaliculi into the lacrimal sac was visualized endonasally. Nasal mucosa was incised using a keratome and a bony ostium was created with the Holmium: YAG laser. Bicanalicular silicone tubes were inserted. Results Five children with a mean follow-up of 25.6 months (range 21-48 months) and a mean age of 7 years were reviewed. Silicone tubes were used in four patients and were removed at a mean 6.5 months (range 3-9 months). One patient developed a mucocele 6 months after the procedure requiring excision of the membrane covering the ostium. There were no other immediate or late postoperative complications. Complete cure of symptoms was achieved in all patients and was maintained at final follow up. Conclusion Modified paediatric laser DCR appears to be an encouraging technique for primary nasolacrimal duct obstruction unresponsive to probing. This may be attributable to the modification of excision of mucous membrane, which may prevent regrowth.