Purpose

Published literature for paediatric endoscopic DCR (enDCR) is typically combined with intubation, often requiring a second anaesthetic for tube removal. We report outcomes of consecutive children undergoing enDCR for congenital nasolacrimal duct obstruction (CNDLO) without intubation. Intubation was omitted where a normal internal ostium, healthy mucosa, full osteotomy allowing complete sac marsupialisation and flaps formation for primary intention healing were all satisfied.

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Methods

Retrospective, single-centre review of paediatric enDCR between 2010-2025.
Outcome measures included the validated TEARS grading for epiphora, need for further procedure, complications.

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Results

Of 56 enDCRs performed in 47 children, 37 were not intubated (mean age 5, range 13 months to 13 years). Mean follow-up was 8 months (range 2 months-9 years). A single procedure was carried out in 35/37 patients. Significant improvement or resolution was found in 92%, partial in 5% and incomplete in 3%. A ≥ 2-point and ≥ 1-point improvement in T-score was achieved in 84% and 92% respectively (mean -3 ±1.3). A ≥2-point improvement was achieved in 76% (mean -3 ±1.7) for E-score. Patients were either unaffected pre-operatively or had ≥ 1-point improvement in 95% (mean -1 ±0.9) and 94% (mean 0 ±0.8) for A and R scores, respectively.

Two patients required revision enDCR (without MMC) due to persistent symptoms and were found to have a phimosed soft tissue ostium. Symptoms resolved in one and the second awaits revision with Mitomycin-C. Nineteen surgeries required intubation for membrane lysis due to distal common canalicular obstruction or a lacrimal fistula.

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Conclusion

Omitting intubation during enDCR where a normal internal ostium, healthy mucosa, full osteotomy allowing complete sac marsupialisation and flaps formation for primary intention achieves success rates comparable to published literature with intubation.

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Additional Authors

First name	Last name	Base Hospital / Institution
Raman	Malhotra	Queen Victoria Hospital

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