gms | German Medical Science

104th DOG Annual Meeting

21. - 24.09.2006, Berlin

Diagnostic criteria for probing planning in congenital nasolacrimal duct obstruction: lacrimal sac echographic grading

Meeting Abstract

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  • P. Steindler - "Cosma" Civil Hospital – Camposampiero/Padua, Ophthalmological Department, Camposampiero/Padova, Italy
  • E. Mantovani - "Cosma" Civil Hospital – Camposampiero/Padua, Ophthalmological Department, Camposampiero/Padova, Italy

Deutsche Ophthalmologische Gesellschaft e.V.. 104. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft (DOG). Berlin, 21.-24.09.2006. Düsseldorf, Köln: German Medical Science; 2006. Doc06dogSA.16.02

The electronic version of this article is the complete one and can be found online at:

Published: September 18, 2006

© 2006 Steindler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Better timing of probing in congenital nasolacrimal duct obstruction (CNLDO) is still unknown. One should avoid complications in a high percentage self-solving disease. The relatively higher percentage of failures reported in probings in children older than 13 months is thought to be caused by either inflammatory phenomena, collection of complex cases or functional block with patent outflow lacrimal pathways after probing. Nowadays widely accepted criteria for probing planning in CNLDO are persistent epiphora, age older than one year and abnormal fluorescein disappearance test at ten minutes (FDT_10) values. Abnormal FDT_10 postoperative values may indicate persistence of functional or manifest epiphora.

We perform lacrimal sac echography in children with CNLDO or with different ocular or adnexial suspect pathology (control series) without any sedation. A lacrimal sac echographic grading was obtained basing upon longitudinal and transverse caliper from 0 (no or slight sac perception), 1 (only longitudinal sac enlargement), 2 (mostly transverse sac enlargement) to 3 (both longitudinal and tranverse sac enlargement). Grade 3 was diagnosed in absence of visible swelling of the lacrimal region. In the control series only lacrimal sac grade 0 and 1 were diagnosed. In a prospective surgical series we found that preoperative lacrimal sac grading as 0 and 1 was linked to both surgical and functional probing success; grading as 2 and 3 were significantly correlated to either surgical (unpatency at irrigation, some residual epiphora) or functional (abnormal FDT_10 values) probing failure. Thus, we stress that bilateral lacrimal sac echography in children with CNLDO may be very useful in the probing planning and functional prognosis.

Moreover, lacrimal sac grading 2 and 3 was mostly found in elderly children. Thus, with respect to nasolacrimal probing timing, we think that a delay in probing planning with a significant lacrimal sac enlargement may cause not only inflammatory consequences as supposed by Katowitz, but also some functional problems such as an altered fluid dynamic with stasis phenomena as in the Welham’s so called “sump syndrome”.