Management of Pediatric Traumatic Nasolacrimal Duct Obstruction and Predictors for Surgical Outcomes.

PURPOSE: The purpose of this study was to evaluate the clinical features, surgical treatments, and outcomes of pediatric post-traumatic nasolacrimal duct obstructions and predictors for surgical outcomes.

METHODS

A retrospective chart review was performed of patients under the age of 18 years with the diagnosis of traumatic nasolacrimal duct obstructions during an 11-year period from a tertiary referral center. The clinical data were reviewed and analyzed. A binary logistic regression was performed to establish a predictive model for surgical failure after treatment.

RESULTS

Eighty-three eyes of 80 consecutive patients were included in the study. Anterior displacement of the lacrimal sac was noted in 71.1% (59/83) cases. Medial canthus deformities were observed in 79.5% (63/83) cases. External dacryocystorhinostomy and endoscopic dacryocystorhinostomy were performed on 65 and 18 cases, respectively. At a mean follow-up of 28 months following stent removal, anatomical and functional success rate was noted in 83.1% (69/83). The presence of orbital fractures involving the rim, gross skin scaring, lacrimal sac displacement, and fracture fragments in the vicinity of the lacrimal sac were found to be significant predictors for surgical failure. The area under the raw current curves of the predictive model was 0.888.

CONCLUSION

This large series of post-traumatic pediatric nasolacrimal duct obstructions showed that sac-duct junction was the most common site of obstruction and anterior displacement of the lacrimal sac and bony fragments in the lacrimal sac area were significant predictors of failures. Medial canthal deformities can be addressed simultaneously with good outcomes.