Study of Primary Surgical Treatment of Nasolacrimal Duct Obstruction in Children Less Than Four Years Old (NLD1)

February 26, 2010 updated by: Jaeb Center for Health Research

A Prospective Study of Primary Surgical Treatment of Nasolacrimal Duct Obstruction in Children Less Than Four Years Old

The purpose of this study is:

  • To report the success proportions of simple probing within different age groups of patients under 24 months of age.
  • To obtain descriptive data regarding symptoms and quality of life in patients receiving simple probing.
  • To obtain similar data for simple probing in patients 24 months of age or older, for intubation in patients age 6 - <48 months, and for balloon catheter dilation in patients age 6 - <48 months.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Nasolacrimal duct obstruction (NLDO) is a common ocular condition in the first year of life. Most cases will resolve spontaneously or with massage. Many studies of primary treatment of nasolacrimal duct obstruction have been reported. These case series have largely been retrospective, uncontrolled, and conducted in single centers.

Simple probing is the most widely-used initial treatment for NLDO in infancy. Two differing approaches to simple probing have been most often been used, immediate office probing (early probing-generally after 6 months of age), and medical management (episodic antibiotic drops with massage of the lacrimal sac) until 9-13 months of age followed by probing under general anesthesia (late probing). The possible advantages of early probing are the avoidance of general anesthesia, immediate resolution of symptoms, lesser cost, and prevention of fibrosis from inflammation in the nasolacrimal duct. The advantages of late probing include more comfort with the procedure and the avoidance of the procedure completely. Both early and late probing approaches are usually successful for treatment of NLDO in patients under 2 years of age, with reported success proportions varying from between 54% to 98%. Although a number of studies have found that probing was highly successful and without an age-related decline until at least 4 years of age and beyond, there is a suspicion among other clinicians of a clinically-important decline in the success proportions among progressively older age groups of preschool children. A large prospective interventional case series might help to clarify whether there is an age-related decline in success.

Balloon catheter dilation has become popular for the initial surgical treatment of NLDO especially in children older than one year. This procedure involves probing of the nasolacrimal duct with a semiflexible wire probe with an inflatable balloon on the tip.

Nasolacrimal intubation has been used for primary treatment by clinicians in older children or when the duct feels tight. While generally successful, there is less certainty of the success proportions for this procedure when performed as a primary treatment. It is also unknown how often this procedure is used for initial treatment.

Probing of the nasolacrimal duct for the repair of NLDO is a very successful procedure in infancy and childhood. Simple probing has long been the standard approach, though the age at which the procedure declines in effectiveness is controversial. Clinicians have been urged by manufacturers of medical equipment to consider intubation and balloon dilation even in the age range in which probing is highly successful, to further increase the chance of success.

A prospective non-randomized study of the outcomes from many centers of all strategies might allow better estimates of success for the techniques most often used over an extended age range. Such a study might help to define factors associated with failure of each of the techniques.

The study has been designed as an observational study that approximates standard clinical practice. All procedures are consistent with standard care with the exception of a questionnaire which the patient's parent will complete at each study visit on NLDO symptoms and quality of life. The surgical center is not engaged in the research and no data will be collected by surgical personnel.

Treatment success is defined as the absence of any clinical signs of nasolacrimal duct obstruction: presence of epiphora, increased tear film, or mucous discharge.

Study Type

Observational

Enrollment (Actual)

973

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Maryland
      • Baltimore, Maryland, United States, 21287-9028
        • Wilmer Eye Institute
    • Pennsylvania
      • Lancaster, Pennsylvania, United States, 17601
        • Family Eye Clinic

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

10 months to 2 years (Child)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

community sample

Description

Inclusion Criteria:

  • Age 6 - < 48 months
  • Parent/guardian has the ability to complete a written questionnaire
  • For patients with two eyes requiring surgery at enrollment: investigator is planning to perform the same type of surgical procedure on both eyes
  • Onset of NLDO symptoms and/or signs prior to 6 months chronological age
  • Presence of epiphora, increased tear film, and/or mucopurulent discharge in the absence of an upper respiratory infection or an ocular surface irritation
  • Undergoing primary NLDO surgery

Exclusion Criteria:

  • History of nasolacrimal duct surgery including simple probing, nasolacrimal intubation, balloon catheter dilation, or dacryocystorhinostomy
  • Glaucoma present
  • Corneal surface disease

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Prospective

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Jaeb Center for Health Research

Collaborators

National Eye Institute (NEI)

Investigators

  • Study Chair: Michael X. Repka, M.D., Wilmer Eye Institute
  • Study Chair: David I. Silbert, M.D., Family Eye Group

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

February 1, 2005

Study Completion (Actual)

September 1, 2006

Study Registration Dates

First Submitted

April 14, 2006

First Submitted That Met QC Criteria

April 14, 2006

First Posted (Estimate)

April 18, 2006

Study Record Updates

Last Update Posted (Estimate)

March 2, 2010

Last Update Submitted That Met QC Criteria

February 26, 2010

Last Verified

January 1, 2010

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • NEI-116
  • 2U10EY011751 (U.S. NIH Grant/Contract)
  • 5U10EY011751 (U.S. NIH Grant/Contract)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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