Abstract
Aim: To determine the etiological and demographic characteristics of congenital nasolacrimal duct obstruction (CNLDO) and to evaluate the effectiveness of probing.
Methods: The study included 33 children who applied to the clinic with epiphora, were diagnosed with CNLDO and underwent probing, and 27 healthy children. Age, gender, probing time, recurrence, accompanying anomalies, and hemogram values were recorded from their records, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR) and systemic immune-inflammation index (SII) were calculated. The term "successful probing" refers to achieving complete resolution of all signs and symptoms of epiphora 1 year after treatment.
Results: The mean age at the time of surgery of 33 patients who underwent probing (16 F, 17 M) was 18.42±7.85 months, while the mean age of the 27 controls (10 F, 17 M) was 22.30± 9.98 months (p=0.108). Platelet levels were significantly lower (p=0.014) and monocyte levels were significantly higher (p=0.012) in the CNLDO group. While there were no significant differences in SII, NLR, and PLR values, the MLR value was significantly higher in the CNLDO group (p=0.026). Recurrence was detected in four patients (12.2%). In the CNLDO group, three patients had undescended testicles, one patient had an inguinal hernia, and one patient had a cleft palate. No significant difference was found between probing time and systemic inflammatory markers and recurrence (for all values p> 0.05).
Conclusion: Platelet, monocyte levels, and MLR ratio were closely associated with CNLDO. Additional anomalies may accompany CNLDO. Successful results can be obtained with probing in the following months.
Keywords: congenital nasolacrimal duct obstruction, epiphora, probing, systemic immune-inflammation index
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Copyright © 2024 The Author(s). This is an open-access article published by Bolu İzzet Baysal Training and Research Hospital under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.
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References
- Farat JG, Schellini SA, Dib RE, Santos FGD, Meneghim RLFS, Jorge EC. Probing for congenital nasolacrimal duct obstruction: a systematic review and meta-analysis of randomized clinical trials. Arq Bras Oftalmol. 2021; 84(1): 91-8. https://doi.org/10.5935/0004-2749.20210005
- Natarajan K, Kasturi N, Sistla S. Assessment of Perinatal Clinical Characteristics, Perinatal Risk Factors, and Microbial Profile in Congenital Nasolacrimal Duct Obstruction in a Tertiary Care Center: A Descriptive Study. Korean J Ophthalmol. 2022; 36(4): 366-373. https://doi.org/10.3341/kjo.2022.0013
- Katowitz JA, Welsh MG. Timing of initial probing and irrigation in congenital nasolacrimal duct obstruction. Ophthalmology. 1987; 94(6): 698-705. https://doi.org/10.1016/s0161-6420(87)33392-5
- Lekskul A, Preechaharn P, Jongkhajornpong P, Wuthisiri W. Age-Specific Outcomes of Conservative Approach and Probing for Congenital Nasolacrimal Duct Obstruction. Clin Ophthalmol. 2022; 16: 1821-8. https://doi.org/10.2147/OPTH.S362680
- Petris C, Liu D. Probing for congenital nasolacrimal duct obstruction. Cochrane Database Syst Rev. 2017; 7(7): CD011109. https://doi.org/10.1002/14651858.CD011109.pub2
- Serin D, Buttanri IB, Sevim MS, Buttanri B. Primary probing for congenital nasolacrimal duct obstruction with manually curved Bowman probes. Clin Ophthalmol. 2013; 7: 109-12. https://doi.org/10.2147/OPTH.S39926
- Kapadia MK, Freitag SK, Woog JJ. Evaluation and management of congenital nasolacrimal duct obstruction. Otolaryngol Clin North Am. 2006; 39(5): 959-77, vii. https://doi.org/10.1016/j.otc.2006.08.004
- Ceylanoglu KS, Acar A, Sen E. Overview of Epiphora Referred to Oculoplastic Surgery Clinic in Adults. Beyoglu Eye J. 2023; 8(1): 45-9. https://doi.org/10.14744/bej.2023.38980
- Karti O, Karahan E, Acan D, Kusbeci T. The natural process of congenital nasolacrimal duct obstruction and effect of lacrimal sac massage. Int Ophthalmol. 2016; 36(6): 845-9. https://doi.org/10.1007/s10792-016-0208-5
- Świerczyńska M, Tobiczyk E, Rodak P, Barchanowska D, Filipek E. Success rates of probing for congenital nasolacrimal duct obstruction at various ages. BMC Ophthalmol. 2020; 20(1): 403. https://doi.org/10.1186/s12886-020-01658-9
- Pediatric Eye Disease Investigator Group. Resolution of congenital nasolacrimal duct obstruction with nonsurgical management. Arch Ophthalmol. 2012; 130(6): 730-4. https://doi.org/10.1001/archophthalmol.2012.454
- Takahashi Y, Kakizaki H, Chan WO, Selva D. Management of congenital nasolacrimal duct obstruction. Acta Ophthalmol. 2010; 88(5): 506-13. https://doi.org/10.1111/j.1755-3768.2009.01592.x
- Arora S, Koushan K, Harvey JT. Success rates of primary probing for congenital nasolacrimal obstruction in children. J AAPOS. 2012; 16(2): 173-6. https://doi.org/10.1016/j.jaapos.2011.12.151
- Dotan G, Nelson LB. Congenital nasolacrimal duct obstruction: common management policies among pediatric ophthalmologists. J Pediatr Ophthalmol Strabismus. 2015; 52(1): 14-9. https://doi.org/10.3928/01913913-20141028-01
- Schellini SA, Ariki CT, Sousa RLF, Weil D, Padovani CR. Management of congenital nasolacrimal duct obstruction--latin american study. Ophthalmic Plast Reconstr Surg. 2013; 29(5): 389-92. https://doi.org/10.1097/IOP.0b013e31829bb162
- Al-Faky YH, Al-Sobaie N, Mousa A, et al. Evaluation of treatment modalities and prognostic factors in children with congenital nasolacrimal duct obstruction. J AAPOS. 2012; 16(1): 53-7. https://doi.org/10.1016/j.jaapos.2011.07.020
- Limbu B, Akin M, Saiju R. Age-based comparison of successful probing in Nepalese children with nasolacrimal duct obstruction. Orbit. 2010; 29(1): 16-20. https://doi.org/10.3109/01676830903207844
- Perveen S, Sufi AR, Rashid S, Khan A. Success rate of probing for congenital nasolacrimal duct obstruction at various ages. J Ophthalmic Vis Res. 2014; 9(1): 60-9.
- Sathiamoorthi S, Frank RD, Mohney BG. Incidence and clinical characteristics of congenital nasolacrimal duct obstruction. Br J Ophthalmol. 2019; 103(4): 527-9. https://doi.org/10.1136/bjophthalmol-2018-312074
- Mohney BG. Association between congenital nasolacrimal duct obstruction and mode of delivery at birth. J AAPOS. 2019; 23(2): 125. https://doi.org/10.1016/j.jaapos.2019.01.002
- Spaniol K, Stupp T, Melcher C, Beheiri N, Eter N, Prokosch V. Association between congenital nasolacrimal duct obstruction and delivery by cesarean section. Am J Perinatol. 2015; 32(3): 271-6. https://doi.org/10.1055/s-0034-1383847
- Gul A, Aslan K, Karli R, Ariturk N, Can E. A Possible Cause of Nasolacrimal Duct Obstruction: Narrow Angle Between Inferior Turbinate and Upper Part of the Medial Wall of the Maxillary Sinus. Curr Eye Res. 2016; 41(6): 729-33. https://doi.org/10.3109/02713683.2015.1052520
- Makselis A, Petroska D, Kadziauskiene A, et al. Acquired nasolacrimal duct obstruction: clinical and histological findings of 275 cases. BMC Ophthalmol. 2022; 22(1): 12. https://doi.org/10.1186/s12886-021-02185-x
- Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol. 2008; 102(6): 653-7. https://doi.org/10.1016/j.amjcard.2008.05.006
- Azab B, Daoud J, Naeem FB, et al. Neutrophil-to-lymphocyte ratio as a predictor of worsening renal function in diabetic patients (3-year follow-up study). Ren Fail. 2012; 34(5): 571-6. https://doi.org/10.3109/0886022X.2012.668741
- Atum M, Alagöz G. Blood cell ratios in patients with primary acquired nasolacrimal duct obstruction. Ophthalmol J. 2020; 5: 76-80. https://doi.org/10.5603/OJ.2020.0017
- Lee KA, Chandler DL, Repka MX, et al. A comparison of treatment approaches for bilateral congenital nasolacrimal duct obstruction. Am J Ophthalmol. 2013; 156(5): 1045-50. https://doi.org/10.1016/j.ajo.2013.06.014
- Al-Faky YH, Mousa A, Kalantan H, Al-Otaibi A, Alodan H, Alsuhaibani AH. A prospective, randomised comparison of probing versus bicanalicular silastic intubation for congenital nasolacrimal duct obstruction. Br J Ophthalmol. 2015; 99(2): 246-50. https://doi.org/10.1136/bjophthalmol-2014-305376
- MacEwen CJ, Phillips MG, Young JD. Value of bacterial culturing in the course of congenital nasolacrimal duct (NLD) obstruction. J Pediatr Ophthalmol Strabismus. 1994; 31(4): 246-50. https://doi.org/10.3928/0191-3913-19940701-11
- Wang D, Xiang N, Hu WK, et al. Detection & analysis of inflammatory cytokines in tears of patients with lacrimal duct obstruction. Indian J Med Res. 2021; 154(6): 888-94. https://doi.org/10.4103/ijmr.IJMR_1435_19
- Matsumura N, Goto S, Uchio E, Nakajima K, Fujita T, Kadonosono K. Cytokine Profiles of Tear Fluid From Patients With Pediatric Lacrimal Duct Obstruction. Invest Ophthalmol Vis Sci. 2017; 58(1): 252-6. https://doi.org/10.1167/iovs.16-20717
- Sathiamoorthi S, Frank RD, Mohney BG. Spontaneous Resolution and Timing of Intervention in Congenital Nasolacrimal Duct Obstruction. JAMA Ophthalmol. 2018; 136(11): 1281-6. https://doi.org/10.1001/jamaophthalmol.2018.3841
- Robb RM. Success rates of nasolacrimal duct probing at time intervals after 1 year of age. Ophthalmology. 1998; 105(7): 1307-10. https://doi.org/10.1016/S0161-6420(98)97038-5
- Pakoz ZB, Ustaoglu M, Vatansever S, Yuksel ES, Topal F. Serum Immune-Inflammation Index Assessment in the Patients with Ulcerative Colitis. Gastroenterol Res Pract. 2022; 2022: 9987214. https://doi.org/10.1155/2022/9987214
- Inagaki N, Kibata K, Tamaki T, Shimizu T, Nomura S. Prognostic impact of the mean platelet volume/platelet count ratio in terms of survival in advanced non-small cell lung cancer. Lung Cancer. 2014; 83(1): 97-101. https://doi.org/10.1016/j.lungcan.2013.08.020
- Kisacik B, Tufan A, Kalyoncu U, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine. 2008; 75(3): 291-4. https://doi.org/10.1016/j.jbspin.2007.06.016
- Demir M, Demir C, Keceoglu S. The Relationship Between Blood Monocyte Count and Coronary Artery Ectasia. Cardiol Res. 2014; 5(5): 151-4. https://doi.org/10.14740/cr315w