PEDIATRICS Efficacy of probing for children with congenital nasolacrimal duct obstruction: a retrospective study using fluorescein dye disappearance test and lacrimal sac echography Piero Steindler & Enrico Mantovani & Carlo Incorvaia & Francesco Parmeggiani Received: 28 August 2008 / Revised: 6 November 2008 / Accepted: 2 December 2008 / Published online: 24 December 2008 # Springer-Verlag 2008 Abstract Purpose To evaluate B-scan echography for the assessment of lacrimal sac (LS) in pediatric epiphora secondary to congenital nasolacrimal duct obstruction (CNLDO), and to verify its predictive role in functional efficacy of nasolacri- mal duct probing. Patients and Methods Thirty-nine eyes of 23 consecutive children, treated with a single probing for persistent CNLDO- related epiphora, were retrospectively studied. These cases were investigated both collectively and considering two sub- groups: group A (ten patients [20 eyes] ≤13 months) and group B (13 patients [19 eyes] >13 months. Fluorescein dye disappearance test at 10 minutes (FDDT-10) and ultrasound examination of LS were performed before and after probing. An echographic LS scoring system (grade 0 = no LS enlarge- ment; grade 1 = slight longitudinal LS enlargement; grade 2 = longitudinal and slight transverse LS enlargement; grade 3 = marked longitudinal and transverse LS enlargement) was introduced as a predictor of probing efficacy, estimating FDDT-10 modification between pre- and post-operative checks. Results Echographic LS evaluation was easily practicable without sedation. In the total cluster and in both age sub- groups, post-probing FDDT-10 decreased with respect to pre-probing value (p <0.001). Post-probing LS score im- proved with respect to pre-probing check within the total cluster and group A (p <0.05). Strong correlation between pre-probing LS alteration and functional probing failure was present in each studied cluster (all p values<0.0001). Within group B, a greater gain of post-probing FDDT-10 was more frequent in patients with a better pre-probing LS score, as well as in younger children (both p values<0.0001). Conclusions In children with CNLDO-related epiphora, B- scan echography of the LS can represent a reliable and useful examination for a better understanding of the functional prognosis after probing treatment. Keywords Congenital nasolacrimal duct obstruction . Epiphora . Nasolacrimal duct probing . Lacrimal sac echography . Functional lacrimal patency Introduction Congenital nasolacrimal duct obstruction (CNLDO) is a common ophthalmic disorder of infancy. Its estimated incidence ranges between 5% and 20%. In newborns, CNLDO clinical signs vary from slight transient epiphora to severe, persistent and purulent discharge [1–4]. Sponta- neous resolution of epiphora occurs in an elevated percentage of children especially [1, 5, 6], but not only [6–8], during the first year of life. Persistent deficiency of nasolacrimal duct canalization causes unresolved epiphora, Graefes Arch Clin Exp Ophthalmol (2009) 247:837–846 DOI 10.1007/s00417-008-1022-1 The authors have full control of all primary data, and they agree to allow Graefe’ s Archive for Clinical and Experimental Ophthalmology to review their data upon request. P. Steindler : E. Mantovani Unit of Ophthalmology, ULSS 15 Alta Padovana, Camposampiero Hospital, Camposampiero, Italy C. Incorvaia : F. Parmeggiani Department of Ophthalmology, University of Ferrara, Ferrara, Italy F. Parmeggiani (*) Sezione di Clinica Oculistica, Dipartimento di Discipline Medico-Chirurgiche della Comunicazione e del Comportamento, Università degli Studi di Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy e-mail: francesco.parmeggiani@unife.it