Outcome of Balloon Dacryoplasty in Congenital Nasolacrimal Duct Obstruction with Failed Probing and Stenting

Purpose: Congenital nasolacrimal duct obstruction (CNLDO) spontaneously resolves with conservative care during the first few months of life in the majority (90%) of cases. Nasolacrimal duct probing is often required to address persistent obstruction and is successful in the majority (78%-97%) of patients. There are several options for recalcitrant CNLDO, including repeating nasolacrimal duct probing, stenting of the lacrimal system, balloon catheter dilation of the nasolacrimal duct (balloon dacryoplasty), and dacryocystorhinostomy. The purpose of this study was to evaluate the effectiveness of balloon dacryoplasty in a series of CNLDO patients who had failed to respond to prior probing and stenting of nasolacrimal duct. Methods: Consecutive patients with CNLDO who had persistent epiphora after previous probing and stenting of nasolacrimal duct who were referred to a tertiary eye hospital were included. Fluorescein dye disappearance test was used in the clinic to assess the patency of lacrimal drainage system before and after operation. Balloon dacryoplasty was performed by a single surgeon and involved passing a lubricated, inflatable balloon along a guide wire into the nasolacrimal duct and through the level of obstruction. The balloon was then inflated for 90 seconds to dilate the obstruction, deflated, and re-inflated a second time or removed. Outcomes (resolution or persistence of epiphora and result of dye disappearance test) were assessed one month after the procedure. Results: Ten eyes of eight patients (5 males and 3 females) were included in the study. Patients were aged 71.6±40.5 months (range, 26-121). Balloon dacryoplasty was successful in 9 eyes (90%). One patient, who had CNLDO and Down’s syndrome, failed to respond to balloon dacryoplasty and subsequently underwent dacryocystorhinostomy. Conclusion: Balloon dacryoplasty can be considered an effective alternative treatment modality in CNLDO patients with history of failed probing and stenting.