الفهرس 
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Abstract
One hundred children complaining of epiphora were enrolled in this prospective study. We selected our cases according to the following inclusion criteria:
- Persistent epiphora in patients above age of 1year and below 18 years old (unilateral, bilateral).
- Possible presence of 1 or more sino-nasal symptoms.
We excluded from the study:
1- patients with other eye conditions such as entropion, ectropion punctal agenesis, ectopic or multiple puncta, blepharitis and conjunctivitis
2- unfit patient.
3-patient with rubbing lash causing epiphora.
4-recurrent epiphora after DCR surgery.
5-patients less than 1 year of age or older than 18 years old.
Sixty-two of our 100 patients had associated sino-nasal or nasopharyngeal pathologies in the form of nasal allergy, adenoid hypertrophy, deviated nasal septum, fungal rhinosinusitis, antro-choanal polyp, or unilateral choanal atresia.
Detailed history was taken from parents of the patients or from older children themselves as regarding:
1-Epiphora
-Unilateral or bilateral
-Constant or intermittent
-Duration (acute or chronic)
2-Sino-nasal symptoms
-Nasal obstruction (unilateral/bilateral)
-Nasal discharge (unilateral/bilateral) + onset, course, duration and its characters.
-History of snoring
-Allergic manifestations (sneezing, itching and rhinorrhea).
3-History of trauma (accidental or surgical)
4-Presence of irritation and prior intervention, including medication or surgery
*Full clinical assessment has been done for the patients in the form of:
a-complete E.N.T examination including rigid nasal endoscopy to assess:
-Nasal septum, turbinates
-Inferior meatus for masses that could be causing obstruction
-Middle meatus for signs of inflammation, mucopurulent discharge or polyp
-Choanae and nasopharynx to exclude choanal atresia and adenoid hypertrophy.
Visualization of the adenoids by fiberoptic nasopharyngoscopy is another option for evaluating adenoids in the clinical setting with good reliability.
b- Complete ophthalmological evaluation including:
-Inspection of the eyelid for mal-positions including entropion, ectropion and horizontal laxity
-Inspection of the puncti and note their patency
-Palpation of the lacrimal sac for evidence of swelling followed by regurgitation test.
All of our 100 patients took conservative medical measures that are make an improvement of epiphora in 25 patients (25% of cases).
The first option for uncured cases by conservative measures includes endoscopic guided probing and syringing of the lacrimal system in 34 children aged 1-1.5-year-old. Twenty-four children of them had associated nasal allergy (treated conservatively) or nasopharyngeal adenoid hypertrophy removed by combined technique adenoidectomy (at the same operative session) in the affected patients.
The second option for unrecovered cases by conservative measures is endoscopic guided nasolacrimal intubation. Nasolacrimal intubations were performed under general anesthesia for previously failed probing (3 cases) and 24 children between 1.5 to 8 years old. Seventeen children of these 24 cases had associated nasopharyngeal adenoid hypertrophy, deviated nasal septum, or unilateral choanal atresia that are corrected (at the same operative session) in the affected children.
The third treatment option for resistant cases of excessive lacrimation involves endoscopic DCR in 2 cases that fail to resolve with intubation and for 17 cases that had recurrent or chronic dacryo-cystitis aged 9-18 years old. Eleven cases of them had epiphora accompanied by nasopharyngeal or sino-nasal disorder that are corrected (at the same operative session) in the diseased cases.
from all of the above, it is clearly evident that correction of concomitant nasal or nasopharyngeal disease that may exacerbate the epiphora and Intraoperative use of nasal endoscopy which provides more orientation to the occlusion site, minimizes false passages, and decreases the requirement for other procedures lead to high success rate and low morbidity in treatment of pediatric epiphora.