Balloon Dilatation for Treatment of Resistant Nasolacrimal Duct Obstruction Kelly A. Huteheson, MD, Arlene V. Draek, MD, and Scott R. Lambert, MD Purpose: Our purpose was to report our experience with balloon catheter dilatation for resistant nasolacrimal duct obstruction. Methods: Patients enrolled had symptoms of nasotacrimal duct obstruction and (1) had failed previous probing or (2) were more than 2 years old. Balloon dilatation was performed with a LacriCATH lacrimal catheter (Atrion Medical Products, Birmingham, Ala.). A subset of patients had Silastic silicone rubber (Dow Coming, Midland, Mich.)intubation after balloon dilatation. Success was determined by clinical examination a minimum of 6 weeks later. Results:Twenty-one lacrimal systems of 12 patients were treated (age range 4 months to 7 years). Of the patient subset treated with a LacriCATH lacrimal catheter alone, 9 of 18 systems demonstrated complete resolution of symptoms. Three of the 12 patients underwent balloon dilatation intraoperatively after attempts at Silastic silicone rubber intubation were unsuccessful. In two of these patients, who were younger, Silastic silicone rubber tubes passed easily after balloon treatment; however, in an older patient, age 5 years, intubation still could not be accomplished. Conclusion: Common clinical strategy for treatment of resistant nasolacrimal obstruction includes repeat probing, intubation of the nasolacrimal system with Silastic silicone rubber tubes, or dacryocystorhinostomy. Balloon catheter dilatation is an alternative or adjunctto consider. Factors that may affect the success of treatment include the age of the patient, the complexity of the nasolacrimal anatomy, and use of adjunctive systemic antibiotics and steroids. {J AAPOS 1997;1:241-4) N asolacrimal duct obstruction is a common problem that has been estimated to occur in up to 6% of term infants.1 Although lacrimal system obstruction resolves spontaneously in most cases, a subset of patients have persistent symptoms that require treat- ment. Before age 1 year, probing is effective in 88% to 97% of patients. 2-4 Patients who do not respond to the initial probing may be treated with repeat probing or with Silastic (Dow Corning, Midland, Mich.) silicone rubber intubation of the nasolacrimal system. Multiple studies have shown that the rate of success of first-time probing decreases with the age of the patient. 3-6 Repeating the probing may also yield lower success rates as patient age increases; with prolonged obstruc- tion and repeated episodes of infection, scarring and stricture along the system may result, making successful probing more difficult. In patients >18 months old success rates for repeat probing have been reported to From the Emory Eye Center, Emory University, Atlanta. Supported in part by a Departmental Grant from Research to Prevent Blindness, Inc., New York, and P30 EY06360 (a National Institutes of Health Departmental Core Grant, Bethesda, Maryland). Presentedat the annual meeting of the American Association for Pediatric Ophthalmology and Strab~mtr, Charleston,South Carolina,April 2-6, 199Z Reprint requests: Scott R. Lambert, MD, Emory Eye Center, Emory University, 1365-B Cleon Road, N.E., Atlanta, GA 30322. Copyright © 1997 by theAmericanAssodation for PediatricOphthalmology and Strabism~. 1091-8531/97 $5.00 + 0 75/1/84882 be as low as 20%. 4 Thus some pediatric ophthalmolo- gists advocate Silastic silicone rubber intubation after failed probing in these children. However, this proce- dure is technically difficult and may be associated with complications. Lacrimal balloon dilatation is an attrac- tive alternative because of its simplicity to perform and the minimal follow-up care required. Recently, the LacriCATH balloon lacrimal catheter (Atrion Medical Products, Birmingham, Ala.), a one-piece balloon catheter consisting of a small polyurethane inflatable balloon on a semiflexible guidewire, has been made commercially available. Results of treatment for resis- tant nasolacrimal duct obstruction with this device have been reported to be as high as 94%,7 but no results have been reported in the pediatric ophthalmology literature to date. We herein report our initial experience with lacrimal balloon dilatation with the LacriCATH device. MATERIALS AND METHODS Patient Population All patients treated had symptoms of persistent nasolacri- real duct obstruction who had (1) failed previous probing or (2) were more than 2 years old. Balloon Dilatation Preoperative medications were given in the presence of active infection. Dilatation was accomplished in the operating room with the patient under general anesthe- ~ournal of AAPOS December 1997 2 4 1