Sathiamoorthi S, et al. - In a large cohort of children with congenital nasolacrimal duct obstruction (CNLDO), the authors sought to report new findings regarding spontaneous resolution. Since the rate of spontaneous resolution plateaued after 9 months and initial probing success declined after 15 months probing between age 9 and 15 months could be reasonable in children with CNLDO. Both an earlier and narrower range of ages for intervention vs the current practice of probing after age 1 year is supported by this time frame.

Methods

• Researchers retrospectively reviewed the medical records of 1998 consecutive infants diagnosed with CNLDO from January 1, 1995, through December 31, 2004, while residing in Olmsted County, Minnesota.
• They analyzed the data between January 1, 2015, and January 2017.
• Main outcomes and measures included the rate of spontaneous resolution over time and by sex.

Results

• Findings suggested that the cohort, diagnosed at a median age of 1.2 months (interquartile range, 0.4-3.6), was 48% girls (n = 959) and 89% white (n = 1626; 173 were unreported).
• As per data, out of the 1998 cases, 1669 (83.5%) spontaneously resolved, 289 (14.5%) underwent treatment, and the remaining 40 (2.0%) were lost to follow-up.
• Out of the 1958 infants followed up, by age 3 months, CNLDO spontaneously resolved in 925 (47.3%), by 6 months in 1300 (66.4%), by 9 months in 1472 (75.7%), and by 12 months in 1516 (78.4%).
• Results demonstrated that the rate of resolution was 35% faster (95% CI, 23%-47%; P < .001) at less than 1 month vs 3 months, 43% faster (95% CI, 27%-64%;P < .001) at 3 months vs 6 months, 39% faster (95% CI, 16%-64%;P < .001) at 6 months vs 9 months, and 1% slower at 9 months vs 12 months (hazard ratio, 0.99; 95% CI, 0.80-1.22;P=.78).
• In boys, congenital nasolacrimal duct obstruction resolved 0.5 months (95% CI, 0.2-0.8;P < .001) faster than girls (median, 2.9 vs 3.4 months), and unilateral obstructions resolved 0.2 months (95% CI, 0.1-0.4;P=.002) faster than bilateral (median, 3.1 vs 3.3 months) ones.
• Decreased odds of resolution were seen in the children probed at 15 months or older after probing (odds ratio, 0.11; 95% CI, 0.01-0.89;P=.04) compared with children probed at age 12 to 14 months.