Læknablaðið - 15.06.1997, Blaðsíða 78

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LÆKNABLAÐIÐ 1997; 83
proportion (72%) of the cases. Genetic factors
accounts for a half of the prenatal cases. In 5.7%
only, the presumed etiologic factor was intro-
duced in the infantile-juvenile period of life.
The predominant causes of visual impairment
are congenital malformations, neuro-ophthalm-
ological diseases and retinal diseases. Optic atro-
phy (14.9%) is the leading single cause of severe
visual impairment.
The proportion of visually impaired children
with an additional mobility, hearing or mental
impairment is about 63%, thus indicating the
need for interdisciplinary tracing and care for the
visually impaired child.
A-10. Serious eye injuries in Iceland
1987-1995
Haraldnr Sigurðsson, Birna Guðmundsdóttir,
Harpa Hauksdóttir
From The Department of Ophthalmology, Uni-
versity of Iceland, Reykjavík, Iceland
Introduction: Eye injuries are frequent prob-
lems in most casualty departments. Most of them
are treated without admission, and usually with
success!
Injuries needing admission can often be a chal-
lenge to treat, in spite of modern technology,
often with unpredictable results. Prevention is
therefore of utmost importance.
Material and methods: All patients notes need-
ing admission to the University Eye Department,
Landakotsspítali because of severe eye injuries
were reviewed. Except for few beds at Akureyri,
this is the only ophthalmology department in Ice-
land. This study is compared to a similar one done
by Dr. Guðmundur Viggósson for the year period
1971-1979.
Results: For the years 1987-1995 (nine years)
there were totally 320 patients admitted because
of severe eye injuries, 106 children and 214 adults.
The figures for the year period 1971-1979 (nine
years) were 209 children and 299 adults. This is a
considerable reduction, mainly for children. For
the adult working injuries are most frequent,
mainly at building sites. For the child it usually
happens while playing.
Conclusion: Serious eye injuries are less fre-
quent than they were in Iceland, but certain cate-
gories could more often be prevented.
A-ll. Is there still a role for probing in
congenital naso-lacrimal duct obstruc-
tion?
Young JDH, MacEwen CJ, White PS
From The Departments of Oplithalmology and
Otolaryngology, Ninewells Hospital and Medical
School, Dundee, Scotland
Introduction: For many years probing has been
the standard surgical treatment for congenital na-
so-lacrimal duct obstruction (CNLDO). We will
review four strands of evidence from our own and
other studies, which suggest that in future the
indications for a standard probing should be
much more limited.
Material and methods: This paper is based on
our clinical and research interest, in the manage-
ment of congenital nasolacrimal duct obstruction.
Additional literature was searched for manually
and as a computerised search of Medline to Jan
1977 (Ovid Technologies) using the subject head-
ing lacrimal duct obstruction.
Evidence: Four areas of evidence are relevant.
1. The high incidence of spontaneous remission
in the first three years oflife: Several studies have
demonstrated spontaneous resolution is a com-
mon occurrence. On the basis of our own studies
we advise probing should be delayed until 12
months of age and if symptoms are milder prob-
ing should be further delayed until 18/12 or later,
during which time there may be well be spontane-
ous resolution.
2. The incidence of traumatic stenosis after
probing: Bleeding from the punctum which might
signal trauma to the system was recorded in 12
(20%) of the 60 eyes probed in our prospective
study and another study reported a 44% inci-
dence of canalicular stenosis in patients referred
after a failed first probing elsewhere.
3. The success rate of a standard probing falls
after two years ofage: When a standard probing is
first carried out on children over two years of age
the success rate is lower, down to 33% in one
large study. Additional procedures to improve
the success rate should therefore be considered.
4. No visualisation ofthe lower end ofthe naso-
lacrimal duct: We will demonstrate the evidence
of anatomical variation at the lower end of the
nasolacrimal duct in a series of cases in which
probing was combined with nasal endoscopy.
Discussion: There is no evidence to support a
policy of probing before 12 months of age. Prob-
ing has a high success rate when used appropri-
ately but allows no view of the lacrimal system, in
particular of the lower end of the nasolacrimal
duct where the obstruction is most commonly
located. The increased availability of nasal en-
doscopy offers a means of improving the results in
selected cases.