[Treatment strategy of the lacrimal drainage system inborn obstruction. Part one - conservative and intervention procedures].

The authors evaluated the successfulness of the conservative and intervention therapies combination in inborn lacrimal drainage system obstruction in a study group of 728 infants with 1154 eyes involved, treated at the Department of Ophthalmology, Faculty Hospital Královské Vinohrady (Kings Vineyards), Charles University, Prague, Czech Republic, E.U., during the period May 2004 - January 2011. The Fluoresceine Dye Dilution Test (FDDT) was used as the basic diagnostic test for the choice of the treatment procedure. The conservative therapy by itself, consisting of hydrostatic massages and application of germicide drops was helpful to canalize the lacrimal drainage system in 20 % of treated eyes, mostly in patients up to two months of age. The most of the patients (980 involved eyes), reached the Children outpatients of the Department of Ophthalmology at the age of approximately three months (average, 2.8 months). Since this age, the combination of the therapeutic irrigation with the probing, followed by the hydrostatic massages was indicated. The authors modified the probing technique according to their own experience gained during the endonasal intubation of the lacrimal drainage system by means of silicone tubing. At the phase of Bowmans probe entering the nasolacrimal sac, the probe was turned under the angle of 45 degrees to the vertical axis of the nose with simultaneous pressuring the probe against the orbital margin. By this procedure, the probe was introduced into the medial nasal meatus in the region of maxillary uncinate processus. Up to the end of the sixth month of age of the followed up infants, using the combination of conservative and intervention procedures, the lacrimal drainage system of 1036 eyes (90 %) was canalized. Out of 118 eyes with stenosis remaining even after 6 months of age, using the above-mentioned conservative therapy until the age of one year, 96 lacrimal drainage systems were further canalized. In the remaining 22 eyes (2 %) after the age of 1 year, the intubation of the lacrimal drainage system using the silicone tubing was performed. The total successfulness of our conservative intervention treatment strategy of lacrimal drainage system inborn obstruction up to the age of one year was 98 %.