Syndromic and Nonsyndromic Systemic Associations of Congenital Lacrimal Drainage Anomalies: A Major Review

Abstract

Lacrimal drainage anomalies associated with syndromic and nonsyndromic systemic conditions have certain unique features of their own and their surgical and anesthesia challenges are distinct. Diagnosis of congenital lacrimal drainage anomalies should prompt consideration of the possible presence of associated systemic abnormalities.

Endoscopic dacryocystorhinostomy to treat congenital nasolacrimal canal dysplasia: A retrospective analysis in 40 children

“…Previous studies have shown success rates for pediatric EN-DCR of 58-100%. 20 Leibovitch et al 21 reported that the anatomical patency rate was 100% (endoscopic anastomotic opening), but the success rate (complete disappearance of symptoms) was only 92%. In our experience, EN-DCR is not recommended in children younger than two years.…”

Pediatric dacryocystorhinostomy

“…However, there are exceptional situations such as posttrauma or certain syndromic congenital nasolacrimal duct obstructions (CNLDOs), where a limited septoplasty may be needed, and this entails strict following of certain guidelines by the surgeons. [ 5 6 ] Achieving a good hemostasis in narrower nasal cavities has a bearing on intraoperative comfort and uneventful surgery; however, judicious use of decongestants in consultation with the anesthetist is needed. In addition, an option of a total intravenous anesthesia may be explored as used in adult DCRs and pediatric sinus surgeries.…”

“…[ 7 8 ] The success rates of pediatric external DCR range from 89% to 97.5%, while that of pediatric endoscopic DCR ranges from 58% to 100%. [ 1 2 3 4 5 ]…”

“…Although pediatric DCRs for acquired nasolacrimal duct obstructions are reported to have similar outcomes as compared to patients with persistent CNLDO, this may not be entirely true for syndromic CNLDO. [ 4 5 9 ] Similarly, although some studies have reported no difference in the outcomes of external DCR between adults and pediatric ages this may not be entirely reflective of the pediatric populations as a whole. [ 3 ] However, different pediatric age groups do not appear to be a major prognostic factor for the outcomes as demonstrated in the current study as well as others.…”

“…Complications of endoscopic DCR have been reported in up to 8.6% of the patients and include hemorrhage, granulomas, emphysema, sinusitis, and rare complications such as orbital intracranial traumas. [ 1 2 3 4 5 ] Causes of failures are mostly related to aggressive healing responses resulting in cicatricial closures of ostia and granuloma formation. [ 1 2 3 4 5 ] The measures to be taken to achieve successful outcomes in pediatric DCRs include adequately sized and positioned osteotomy, full-length sac marsupialization, and a 360° mucosa to mucosa approximation to facilitate healing by primary intention.…”