| Congenital nasolacrimal duct obstruction(CNLDO) is a common clinical problem in infant,the chief symptom of CNLDO is persistent epiphora,and it affects closer to 6%of the pediatric population.Treatment of this disorder presents a challenge to ophthalmologists and physicians alike.Conservative management, consisting of observation or massage and antibiotics,may eventually result in resolution of symptoms.Many factors,however,including severity of symptoms, compliance with treatment,and failure of conservative measures,can lead the surgeon and the parents to consider other interventions.Debate continues over the proper timing and procedures for treatment of CNLDO.Lacrimal probing is regarded as a reliable first procedure with a high success rate,most studies show a decreasing success rate with increasing patient's age and more aggressive management is required for persistent epiphora following probing.It is unclear whether probing is less successful when delayed,either by choice or because of late presentation.It is thought that probing could be less successful in older children,perhaps because of prolonged inflammation of the nasolacrimal system resulting in scarfing,or because of accumulation of more severe obstructions with time as less severe ones clear spontaneously or on conservative management.Conversely,there are studies that indicate that primary probing continues to be an effective treatment well beyond 2 years of age and that the cure rate dose not vary markedly with increasing age.Clearly, there is no universally accepted standard approach to the management of CNLDO. The aim of this study is to assess the factors affecting the incidence of CNLDO through the analysis of patient's clinical history.And to find the optimal timing and procedure according the cure rate of different methods in different age.Also,we hope to provide a rationalized plan for the management of CNLDO on the both theory and practice evidence. Part one:Clinical Analysis of Congenital Nasolacrimal Duct ObstructionObjective To find the high risk factors related to the incidence of congenital nasolacrimal duct obstruction(CNLDO) through the analysis of the patient's medical record.Methods In the retrospective study,735 infants(837 eyes) who were diagnosed as CNLDO in Children's Hospital of Fudan University were involved.The patients' gender,involved eye,type of delivery and gestational age were recorded for statistical analysis.Results 837 eyes of 735 patients were evaluated,376(51.2%) patients were boys,359(48.8%) patients were girls.Right and left involvement was seen in 425(50.8%) and 412(49.2%) patients.The type of delivery in 434(59%) patients was natural and 301(41%) patients was cesarean section.The gestational aged≤32W,32～37W,≥37W was 11(1.5%),109(14.8%) and 615(83.7%) patients, respectively.Conclusion Preterm is one of the high risk factors of the incidence of CNLDO.However,gender,involved eye and type of delivery has no significant relation to the incidence of CNLDO.Part two:Therapeutic Research of Congenital Nasolacrimai Duct ObstructionObjective To find the optimal intervention time and methods through the analysis of curative effect by using different methods in different ages of out patient treatment on congenital nasolacrimal duct obstruction(CNLDO).Methods In the retrospective study,735 infants(837 eyes) who were diagnosed as CNLDO in Children's Hospital of Fudan University were involved,the mean age at first examination was 4.5 months. According to age,patients were treated with conservative treatment,high-pressure irrigation or nasolacrimal duct probing in sequence.All patients were followed up at least 3～16 months,the mean time was 6.4 months.Clinical success was defined as complete resolution of epiphora.Results The success rate of this three treatments was 14.7%(123/837),25.4%(181/714),97.2%(518/533) and 15 eyes were failure.And the success rate with one time probing in the early probing group was 87.7%(≤6months) vs.56.6%in the late probing group(≥7months).Conclusion Nasolacrimal duct probing is a safe and effective method in CNLDO treatment.Also,our dates show that the optimal intervention time is 4～6 months.Failure is related to delay in probing which cause inflammation of the nasolacrimal system resulting in scaring and straitness.
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