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ORIGINAL ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 1  |  Page : 5-7

Clinical study of efficacy of probing as a treatment for epiphora in adults


Department of Ophthalmology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India

Date of Submission11-Aug-2016
Date of Acceptance14-Sep-2018
Date of Web Publication12-Mar-2019

Correspondence Address:
Sahana R Manipur
Room No. 704, Hassan Institute of Medical Sciences Ladies Hostel, Hassan Institute of Medical Sciences Campus, Hassan - 573 201, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_75_16

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  Abstract 


Background/Context: Probing is a simple operative procedure, can be performed easily in adults under local anesthesia, and is associated with minimal postoperative morbidity. The study aimed to determine the efficacy of probing in adults with epiphora due to common canalicular block (CCB) and nasolacrimal duct obstruction (NLDO). Materials and Methods: A prospective, interventional study was conducted on 44 patients with epiphora. Probing was done through upper and lower canaliculus under local anesthesia in all patients with epiphora due to CCB and NLDO. Probing was considered successful if the epiphora had been resolved or reduced to an acceptable level and if the lacrimal system was patent on lacrimal syringing for 6 months. Results: Patients comprised 36 women and eight men with the age group between 25 and 80 years who had epiphora for 3–24 months. Twenty-six patients had common CCB and 18 had complete NLDO. Complete patency was achieved in 12 and 5 and partial patency in 9 and 6 patients with CCB and NLDO, respectively. Treatment was successful in 72.72% of the patients. Ten patients underwent uneventful cataract surgery and 12 failed cases needed dacryocystectomy. Conclusion: Since probing is a simple, quick, cost-effective, and daycare procedure with low morbidity and obviates the need for further nasolacrimal surgery, probing can be recommended as an initial treatment in adults with epiphora.

Keywords: Adult epiphora, common canalicular block, nasolacrimal duct obstruction, probing


How to cite this article:
Kavitha C V, Manipur SR, Acharya P, Lakshmi B R. Clinical study of efficacy of probing as a treatment for epiphora in adults. J Clin Ophthalmol Res 2019;7:5-7

How to cite this URL:
Kavitha C V, Manipur SR, Acharya P, Lakshmi B R. Clinical study of efficacy of probing as a treatment for epiphora in adults. J Clin Ophthalmol Res [serial online] 2019 [cited 2019 Mar 21];7:5-7. Available from: http://www.jcor.in/text.asp?2019/7/1/5/253993



Epiphora characterized by overflow of tears from conjunctival sac can be due to partial or total obstruction in the canaliculus, common canaliculus, lacrimal sac, or nasolacrimal duct.[1] Epiphora due to obstruction of the nasolacrimal system is a common ophthalmic problem. Epiphora causes discomfort, visual disturbances, and skin problems such as excoriation. Treatment modalities for epiphora include conservative treatment and operative procedures such as probing, dacryocystorhinostomy (DCR), dacryocystectomy (DCT), conjunctivodacryocystorhinostomy, endoscopic and transcanalicular dacryocystorhinostomy, balloon dacryocystoplasty, lacrimal stents, conjunctivoplasty, and the use of mitomycin C.[2] Balloon dacryocystoplasty is a simple and minimally invasive technique, but this technique is not advisable for the treatment of complete obstruction of the lacrimal drainage system. Balloon dilatation proves to be satisfactory primary treatment for patients with partial obstruction of nasolacrimal duct and patients who are poor candidates for DCR.[3],[4] Silicone intubation of the nasolacrimal system is also found to be successful procedure in the management of adult epiphora.[5] A simple technique of retrograde placement of hollow polyurethane nasolacrimal duct stent is also well tolerated by patients and has high success rate. This procedure is facilitated by Ritleng probe.[6] Probing is a simple operative procedure, can be performed easily in adults under local anesthesia, and is associated with minimal postoperative morbidity. In contrast, other treatments for adult epiphora are more invasive and are associated with a greater risk of complications. Studies have shown that probing is an effective treatment for children aged below 4 months. However, the risk of failure from probing increases with age, doubling every 6 months.[7] The study aimed to determine the efficacy of probing in adults with epiphora due to canalicular block and nasolacrimal duct obstruction (NLDO). Since ours is government setup, patients with common canalicular blocks (CCBs) who were not affordable for stenting were subjected to probing and its efficacy was determined.


  Materials and Methods Top


A prospective, interventional study was conducted on 44 patients with epiphora attending the outpatient department of ophthalmology.

All patients of either sex aged above 18 years with complaints of epiphora due to CCB and NLDO were included in the study. Patients with epiphora secondary to acute dacryocystitis, lacrimal sac mucocele, previous trauma, previous surgical intervention, neoplasia, ectropion, and intranasal pathologies were excluded.

All patients fulfilling the inclusion and exclusion criteria were examined under slit lamp biomicroscopy, and informed consent for the study was obtained after informing the study subjects the details of the procedure and probable complications in their local language.

All patients with symptomatic epiphora and blockade of the lacrimal system are confirmed by lacrimal syringing. If necessary fluorescein dye disappearance test, Jones dye test was done to confirm diagnosis. Ear, nose, and throat evaluation was done, and intranasal pathologies were ruled out. After all necessary investigations and obtaining physician fitness and consent for procedure, they were posted for probing.

Probing was done under local anesthesia. After instillation of lignocaine 4% into conjunctival sac, lignocaine 2% and adrenaline infiltration was done around the medial canthus, lower lid and deep up to the periosteum. Probing was done through upper/lower canaliculus using Bowman probes [Figure 1], [Figure 2], [Figure 3]. Probe was passed through upper/lower punctum, upper/lower canaliculus, lacrimal sac, and NLD. During probing, most of the blocks were membranous and few had combinations of resistance. Patients were followed up postoperatively on day 1, 1 week, 3 weeks, 1 month, 2 months, and 6 months, and in each visit, patients were asked about the complaints of epiphora and lacrimal patency was assessed by lacrimal syringing. Patency was assured with repeated syringing. Conjunctival swab culture was sent in patients with cataract. Postoperatively, the patients were treated with antibiotic (moxifloxacin 0.5%) eye drops 6 times a day for 3 weeks and oral antibiotics (tablet ciprofloxacin 500 mg twice a day) and nonsteroidal anti-inflammatory drugs (tablet diclofenac 50 mg, if required) for 5 days.
Figure 1: Bowman probes

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Figure 2: Probing technique (Step 1)

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Figure 3: Probing technique (Step 2)

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Ethical clearance was obtained from Institutional Ethics Committee of Hassan Institute of Medical Sciences, Hassan.


  Results Top


Patients comprised 36 women and 8 men aged between 25 and 80 years who had epiphora for 3–24 months [Chart 1]. Twenty-six patients had CCB and 18 had complete NLDO [Chart 2]. Treatment was successful in 72.72% of the patients. Ten patients (6 with CCB and 4 with NLDO) underwent uneventful cataract surgery after negative conjunctival swab culture and 12 failed cases needed DCT, considering the old age of the patients and fibrotic sacs [Table 1] and [Chart 3].

Table 1: Outcome of probing

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  Discussion Top


Guinot-Saera et al. conducted retrospective study on adult patients aged 18 or older of either sex who had undergone probing for epiphora.[7] In our study, we included all patients of either sex aged above 18 years with the complaints of epiphora for probing. In a study conducted by Mirza et al., symptomatic improvement was seen in 69.44% with the first probing and 77.78% with the second probing.[1] Guinot-Saera et al. concluded that probing for NLDO in adults with the symptomatic watering has an 82% success in relieving symptoms.[7] Bell et al. found that following single probing procedure, watering was subjectively improved in 52% of cases with epiphora. When patients who had a mucocele or mucous regurgitation were excluded, the improvement rate increased to 75%.[8] Kashkouli et al. found limited success of probing in approximately 50% of the adult patients with NLD stenosis.[9] In our study, probing was successful in 72.72% of cases with epiphora which is close to other related studies.

Tsai et al. investigated the efficacy and safety of adjunctive low-dose mitomycin C during lacrimal probing for adults with blocked NLD and recommended it as a simple, effective, and minimally itnvasive technique, with no significant complications.[10] We also found that uneventful cataract surgeries can be achieved in patients with epiphora and cataract after probing and culture negative conjunctival swab. Limitations of the study were small study group, and in history, we have not looked into hormonal fluctuations in women subjects.


  Conclusion Top


Probing is a simple, quick, cost-effective daycare procedure with low morbidity and obviates the need for nasolacrimal surgery such as DCR and we can go ahead with cataract surgery without any complications after probing and culture-negative conjunctival swab.

Hence, probing is effective in treating patients with epiphora due to CCB and NLDO and can be recommended as an initial treatment in adults with epiphora with good success rate.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mirza SA, Siyal NA, Memon A, Khanzada MA, Muttaqi AE, Mirza AA, et al. Efficacy of probing in young adult in nasolacrimal duct obstruction. Pak J Surg 2012;28:301-4.  Back to cited text no. 1
    
2.
Mandeville JT, Woog JJ. Obstruction of the lacrimal drainage system. Curr Opin Ophthalmol 2002;13:303-9.  Back to cited text no. 2
    
3.
Yazici Z, Yazici B, Parlak M, Erturk H, Savci G. Treatment of obstructive epiphora in adults by balloon dacryocystoplasty. Br J Ophthalmol 1999;83:692-6.  Back to cited text no. 3
    
4.
Perry JD, Maus M, Nowinski TS, Penne RB. Balloon catheter dilation for treatment of adults with partial nasolacrimal duct obstruction: A preliminary report. Am J Ophthalmol 1998;126:811-6.  Back to cited text no. 4
    
5.
Fulcher T, O'Connor M, Moriarty P. Nasolacrimal intubation in adults. Br J Ophthalmol 1998;82:1039-41.  Back to cited text no. 5
    
6.
Yazici B, Yazici Z, Parlak M. Treatment of nasolacrimal duct obstruction in adults with polyurethane stent. Am J Ophthalmol 2001;131:37-43.  Back to cited text no. 6
    
7.
Guinot-Saera A, Koay P. Efficacy of probing as treatment of epiphora in adults with blocked nasolacrimal ducts. Br J Ophthalmol 1998;82:389-91.  Back to cited text no. 7
    
8.
Bell TA. An investigation into the efficacy of probing the nasolacrimal duct as a treatment for epiphora in adults. Trans Ophthalmol Soc U K 1986;105 (Pt 4):494-7.  Back to cited text no. 8
    
9.
Kashkouli MB, Pakdel F, Kiavash V. Assessment and management of proximal and incomplete symptomatic obstruction of the lacrimal drainage system. Middle East Afr J Ophthalmol 2012;19:60-9.  Back to cited text no. 9
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10.
Tsai CC, Kau HC, Kao SC, Hsu WM, Liu JH. Efficacy of probing the nasolacrimal duct with adjunctive mitomycin-C for epiphora in adults. Ophthalmology 2002;109:172-4.  Back to cited text no. 10
    


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