Journal of Clinical and Experimental Ophthalmology
Open Access

Abstract

The First Large Pan-nordic Survey of the Management of Acquired Lacrimal Drainage Obstruction in Adults

Elin Bohman, Jonathan C. P. Roos and Eva Dafgard Kopp

Objective: To survey current practices in the management of acquired lacrimal drainage obstructions in adults in the Nordic countries, and to identify the challenges in providing treatment to aid discussions on which procedures should be offered, how treatment can be improved and services organized.
Method: A detailed questionnaire was sent to 79 ophthalmological clinics performing lacrimal surgery in the five Nordic countries, making this the largest pan-Nordic survey of lacrimal drainage procedures to date. The questionnaire included items on the frequency of lacrimal surgery, the specialty of the surgeon (ENT or ophthalmology), referral rates and current management depending on type of lacrimal obstruction and presence of infection.
Results: The response rate was 65%. Results show the widespread use of canaliculodacryocystoplasty (CDCP) with silicone tube stenting at an early stage both for canalicular stenosis and nasolacrimal duct obstructions (NLDO), but with marked differences in the duration of stenting. After dacryocystitis, dacryocystorhinostomy was the preferred approach but CDCP was considered an option. A conservative approach was generally adopted in the surgical treatment of functional epiphora, and it was unlikely that eyelid surgery would be performed for this indication at about half of the clinics. Respondents reported that a lack of surgical competence and training was their greatest challenge, and that the demand for treatment was greater than the resources available.
Conclusions: The Nordic countries face challenges in terms of training and the provision of lacrimal surgery. The use of CDCP for complete NLDO is controversial as it is not based on solid evidence. The period for which the stent is left in place following CDCP varies in all types of obstruction, and there is a lack of consensus. These findings highlight the need for further studies into both the optimal duration of silicone stenting following CDCP, and the success and cost-effectiveness of CDCP in treating NLDO.