Evaluating a Decade of Surgical Solutions: Pediatric Nasolacrimal Duct Obstruction Treatment Outcomes in Malaysia

This study aims to determine the outcomes of probing and external dacryocystorhinostomy (exDCR) for congenital nasolacrimal duct obstruction (cNLDO) and the factors influencing the success rates in pediatric cNLDO. A retrospective sample collection was conducted at the oculoplastic referral center over 10 years (January 2012 to December 2022) for cNLDO patients who had undergone probing or exDCR. Data were retrospectively reviewed for patients aged ≤18 years who underwent probing or exDCR. Variables namely demographics, clinical presentations, indications for surgery, complications, and surgical outcomes were collected for further interpretation. Success was defined as the improvement of symptoms and resolution of clinical signs after at least six months of follow-up. Logistic regression was performed to analyze factors affecting success rates. A total of 109 patients were included (66 exDCR, 43 probing), with nearly similar male-to-female distribution. Common presentations were epiphora and mucous discharge. The majority of cases were simple cNLDO (91% in the probing group, 88% in the exDCR group). Indications for surgery were dacryocystitis, fistula, canaliculitis, and persistent symptoms despite Crigler massage. The success rates were 60.5% for probing and 86.4% for exDCR. Complications varied between procedures and included fistula, tube dislodgement, and granuloma formation. Younger age and the absence of dacryocystitis were significantly associated with higher success rates in probing. Other factors influencing success rates, included simple cNLDO, bilaterality, and the use of endoscopic guidance despite non-significance statistically. The success rates for probing and exDCR were 60.5% and 86.4%, respectively. Statistically significant factors associated with improved outcomes included younger age and the absence of dacryocystitis. Other factors, such as simple cNLDO, bilaterality of disease, and endoscopic guidance, may also contribute to better outcomes, though they were not statistically significant.