Objective: To evaluate the surgical management and outcomes of congenital nasolacrimal duct obstruction (CNLDO) in children with Down syndrome (DS).
Materials and Methods: This retrospective descriptive study included pediatric patients with DS who were diagnosed with CNLDO and underwent surgical treatment. Demographic characteristics, obstruction sites, surgical procedures, and outcomes were reviewed. Surgical success was classified as complete, partial, or failure based on the resolution of epiphora and discharge.
Results: A total of 43 eyes were evaluated. Proximal, distal, and combined lacrimal obstructions were identified in 23.3%, 41.9%, and 34.9% of eyes, respectively. Probing could not be performed in three eyes (7.0%) because of complete punctal agenesis. Primary surgical intervention was performed in 40 eyes, including probing and irrigation in 39 eyes and bicanalicular silicone intubation in one eye. Among the 39 eyes that underwent primary probing and irrigation, complete success was achieved in 48.7%, partial success in 7.7%, and treatment failure in 43.6%. Following failure of the primary intervention, 14 eyes underwent secondary mono- or bicanalicular silicone intubation, resulting in complete success in 11 eyes (78.6%) and partial success in three eyes (21.4%). In the final per-protocol analysis of 33 eyes that completed the recommended treatment pathway, complete success was achieved in 30 eyes (90.9%), while partial success was achieved in three eyes (9.1%).
Conclusion: Children with DS and CNLDO have a high prevalence of proximal and combined lacrimal system anomalies, which may contribute to lower success rates with primary probing. Although initial probing demonstrated modest success, mono- or bicanalicular silicone intubation was highly effective as a second-line treatment. A stepwise surgical approach resulted in favorable overall outcomes.