Authors: Kailun Jiang, Valerie Juniat, Geoff Rose, Hannah Timlin, Jimmy Uddin, Yassir Abourayyah, Swan Kang, Vijay Wagh, David Verity

Author Disclosure Block: K. Jiang: None. V. Juniat: None. G. Rose: None. H. Timlin: None. J. Uddin: None. Y. Abourayyah: None. S. Kang: None. V. Wagh: None. D. Verity: None.

Abstract Body:

Purpose: Dacryocystorhinostomy (DCR) can be associated with peri- or post-operative epistaxis. Hemorrhage and circulatory compromise are safety concerns for children under 2 years old who undergo lacrimal drainage surgery. In this study, we reviewed the peri- and post-operative complications of external DCR surgery in children under the age of 4 at a single, stand alone ophthalmic unit.
Study Design: Retrospective case review.
Methods: This study reviewed all children under the age of 4 who had undergone DCR surgery at a hospital site between 1998 and 2013. Post-operative telephone survey of parents and guardians were conducted to identify specific post-operative complications.
Results: 67 patients under the age of 4 were treated with DCR (86 DCR procedures). 61% were male. The median age was 27.5 months (range 5-48 months). Median number of probing episodes prior to DCR was 1.8 (range 1-8). The indications for DCR included lacrimal mucocoele in 72%, epiphora in 28% despite probing and recurrent dacryocystitis in 16%. Surgery and anaesthesia were consultant-led in all cases. 72% of patients did not have intubation, while 28% were intubated. Success rate (defined as resolution of mucocoele and epiphora) following one DCR operation was 96%. 3 patients required further surgery for persistent epiphora. 2 patients were treated for soft tissue infection, which resolved with oral antibiosis alone. There were no peri- or post-operative hemodynamic complications. No emergency-room attendances or readmissions for epistaxis occurred, this was also confirmed by telephone survey.
Conclusions: In conclusion, external DCR in an ophthalmic stand-alone unit is safe and effective in young children when performed by experienced surgeons and anesthetists.