To describe the outcomes of balloon catheter dilation of the lacrimal duct as the first surgical treatment for older children (≥18 months) with nasolacrimal duct (NLD) obstruction and to examine the effect of the type of obstruction on outcome.
Retrospective noncomparative case series.
Seventy-six children 18 months or older with NLD obstruction who had not undergone previous surgery.
The patients underwent NLD probing, infracturing of the inferior turbinate, and balloon catheter dilation of the distal NLD. The type of obstruction was noted at surgery.
Main Outcome Measures
Outcomes were considered excellent if the patient had complete resolution of epiphora and dacryocystitis and normal tear drainage on examination, good if the patient had only minimal residual symptoms or a minimally delayed dye disappearance test result, fair if the patient had moderate residual symptoms or delayed tear drainage, and poor if there was no improvement.
Seventy-six children were treated. Overall, results were excellent in 28 (37%) patients, good in 30 (39%), fair in 13 (17%), and poor in 5 (7%). Forty-eight (63%) of the patients had simple membranous obstruction at the Hasner valve. Results were good or excellent in 35 (73%) of these patients. Twenty-eight (37%) patients had stenosis that extended along the length of the distal NLD. Results were good or excellent in 23 (82%) of these patients.
Balloon catheter dilation is probably more effective than simple probing for older children with NLD obstruction because of stenosis that extends along the distal NLD. The procedure does not provide a significant advantage over simple NLD probing in patients with typical membranous obstruction at the Hasner valve.