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Fimiani F., Carelli R., Boccuzzi D., Iovine A.
Dipartimento di Scienze Oftalmologiche Facoltà di Medicina e Chirurgia Università “Federico II”, Napoli, Italia
Aim. The aim of this study was to evaluate the surgical and medical treatments in children affected by Down syndrome suffering from dacryocystitis. Methods. A retrospective study was conducted on 157 patients with Down syndrome. Thirty-five out of 157 were affected by nasolacrimal duct obstruction since their birth (60 eyes). The elective approach in the first 10-12 months of life was a medical treatment (antibiotics drops and massage of the lacrimal sac region); between 12 and 18 months the patients presenting canalicular reflux underwent a syringing of the nasolacrimal duct (19 eyes). Nevertheless, four cases (three children) of relapse after syringing were selected for the procedure of intubation of the lacrimal systemcanaliculus, lacrimal sac, and nasolacrimal duct and two children underwent a dacryocystorhinostomy associated with bilateral intubation. The silicone stent was left in site for nine months. Results. Despite the persistence of frequent chronical conjunctivitis and epiphora, in 23
patients (41 eyes) the medical treatment and massage were effective in the resolution of dacryocystitis. Nasolacrimal duct syringing was performed in 19 eyes (12 patients), and 13 eyes (seven patients) experienced a reflux reduction. In four eyes (three patients) a lacrimal system intubation was necessary and in two eyes (two patients) dacryocystorhinostomy was performed in order to reduce the symptoms. Conclusion. Lacrimal tract obstruction is one of the most frequent clinical eye conditions affecting children with Down syndrome, because of the anatomical abnormalities of their nasolacrimal system. For this reason, a different approach is required (dacryocystorhinostomy and nasolacrimal duct intubation). An early treatment is related to a better prognosis.