The role of nasolacrimal intubation in the management of childhood epiphora

Nasolacrimal intubation has been advocated to obviate the need for dacryocystorhinostomy (DCR) for childhood epiphora which fails to resolve despite apparently successful probings. Twenty-eight intubations were attempted on children falling into this category. Of these, 25 were anatomically successful intubations (3 having had to be abandoned because of difficulties in retrieving the silicone tubes from the nose). Twenty patients (80%) had complete resolution of symptoms, 2 (8%) had improvement of symptoms such that no further intervention was necessary and 3 (12%) proceeded to DCR. A greater likelihood of a good outcome was seen if the tubes were left in situ for 6 months or more. We suggest that primary nasolacrimal intubation (that is nasolacrimal intubation without DCR) should be the next step in the management of childhood epiphora which fails to resolve after two probings. This approach may avoid a DCR in over 80% of children.