Sheth M. L. Vaduwala Charitable Eye Hospital and Dr. Thakorbhai V. Patel Eye Institute

Aims: The aims of our study were (1) to compare success of probing done blindly and probing done under endoscopic assistance (2) to correlate the findings of blind probing with endoscopic examination findings. Materials and Methods: Retrospective comparative interventional case study. Total 98 eyes of 84 children were included in the study. The probing was performed under brief inhalational anaesthesia with a laryngeal mask. All probings, secondary and in children older than 24 months, were performed under endoscopic assistance only. Results: Total 111 probings were done out of which, ninety-eight (88.29%) were primary and 13 (11.71%) secondary. Seventy-six (68.4%) probings were done without and thirty-five(31.53%) probings were done with nasal endoscopic assistance. Out of 35, 22 (19.81%) probings were primary and 13 (11.71%) secondary. The mean age for probing was 18.2 +/- 12.5 months. Thirty eight (45.23%) were females and 46 (54.77%) were males. Out of 76 primary probings, 13 (17.10%) probings failed. The mean age of failed primary probing was 15.2 +/- 6.7 months. All 22 primary probings done under endoscopic guidance had successful outcome. Out of the total 111 probings, 2 (1.80%) probings failed who underwent endonasal dacryocystorhinostomy in the same sitting. Conclusion: Use of simultaneous nasal endoscopy during probing increases the success rate, minimizes secondary procedures and isof prognostic value for children with Congenital nasolacrimal duct obstruction (CNLDO).

Dear Editor, iCare tonometer, a rebound tonometer, is designed to measure intraocular pressure ("IOP") with minimal need for topical anesthesia.[1] The iCare tonometer has been used in children and home screening.[2] However, because the probe of the tonometer is gravity-dependent, it cannot be used validly in an individual who is in a supine position, as the probe, due to gravity, falls and does not rebound [Fig. 1a and b]. We describe a technique to measure IOP with the iCare tonometer in the supine position. This would be helpful in examination under anesthesia children and patients who can sit upright.Figure 1: (a and b) Shows the fall of probe from the tonometer because of gravity. (c) The tonometer can be used easily since the probe is horizontal and would not fall due to gravityThe Technique Placing an anesthetized person in an upright position carries the risk of the tongue blocking the airway, causing hypoxia. This particular risk can be avoided when patients are placed on their side. The technique is as follows: The patient is laid on one side, and the tonometer appropriately tilted to that side (as shown in the [Video 1] and Fig. 1c). The pressure can then be measured. The particular modification is safe for children taken for examination under anesthesia and gives a quick and reliable multiple readings. A similar technique has been used for ND YAG capsulotomy in children under general anesthesia.[3] It also doesn't require a higher end equipment (the iCare pro), which is expensive compared to the I care model.