What are the outcomes of sac syringing for nasolacrimal duct obstruction?

Outcomes of Sac Syringing for Nasolacrimal Duct Obstruction

Sac syringing for nasolacrimal duct obstruction has a moderate success rate of approximately 75% overall, with outcomes varying significantly based on patient age, type of obstruction, and presence of complications. 1, 2

Success Rates by Patient Population

• In children with congenital nasolacrimal duct obstruction (CNLDO), success rates decline with increasing age:

  • 85% success in children aged 2-3 years 2
  • 63% success in children aged 3-4 years 2
  • 50% success in children aged 4-5 years 2
  • Overall success rate of 75.8% in children aged 2-5 years 2

• In infants, conservative management with sac massage has limited effectiveness:

  • Only about 30% success rate with sac massage alone 3
  • Children with mucoid regurgitation on pressure over lacrimal sac (ROPLAS) are almost 6 times more likely to experience failure of sac massage compared to those with clear ROPLAS 3

• For traumatic nasolacrimal duct obstruction, more invasive procedures are typically required:

  • External dacryocystorhinostomy (DCR) with or without silicone intubation has a 96% success rate for traumatic cases 4

Factors Affecting Outcomes

• Age is a significant predictor of success:

  • Success rates decline by approximately 25% for every 6-month increase in age 3, 2
  • Primary probing can still be effective after age 2, but with progressively lower success rates 5, 2

• Type of obstruction impacts outcomes:

  • Patients with chronic dacryocystitis with mucopurulent discharge have better success rates (83%) compared to those with epiphora without mucopurulent discharge (59%) 2
  • Altered nasolacrimal duct anatomy rather than delay in treatment appears to be the primary reason for probing failures 5

• Adjunctive treatments can improve outcomes:

  • Use of Mitomycin-C during endoscopic DCR procedures results in:
    • Reduced granulation tissue formation at 3 months post-procedure 6
    • Decreased adhesion formation 6
    • Larger neo-ostium size 6
    • Maintained 100% success rate at 6 months follow-up 6

Long-term Outcomes

• Successful initial probing resolves tearing and discharge in approximately 90% of patients 5
• An additional 6% of patients achieve resolution after a second probing 5
• For failed cases, dacryocystorhinostomy is an effective secondary procedure 5, 4
• Long-term follow-up is essential to monitor for recurrence of obstruction 1

Complications and Management

• Unsuccessful probings are usually apparent during the initial procedure and characterized by:

  • Difficulty passing the probe 5
  • Inability to irrigate saline through the nasolacrimal system into the nose 5

• For patients over 5 years of age, initial probing has high failure rates, and alternative procedures such as intubation or dacryocystorhinostomy are recommended 2

• Concomitant dacryocystitis (infection of the tear sac) may require additional management 1

Clinical Pearls

• The presence of mucoid discharge on pressure over the lacrimal sac is a negative prognostic factor for success with conservative management 3
• Difficulty during the initial probing procedure is highly predictive of treatment failure 5
• Patients with traumatic nasolacrimal duct obstruction typically require more invasive procedures like DCR rather than simple probing 4
• Adjunctive use of Mitomycin-C during DCR procedures can improve outcomes by reducing granulation tissue and adhesion formation 6