Abstract
Naso lacrimal duct obstruction (NLDO) is the most common cause of epiphora in infants. Conservative management is suggested as most cases usually resolve spontaneously in the first year of life. In most centres, these patients are routinely reviewed by a Consultant Ophthalmologist. To improve efficiencies within our service an extended role clinic (ERC) staffed by a highly specialist Orthoptist with distant consultant supervision was introduced to manage this patient group. This service evaluation aims to review the effectiveness of the ERC.
Retrospective clinical records review of 50 consecutive new patients seen within the ERC with NLDO were assessed for clinical outcomes over two years. The patients underwent an age-appropriate Orthoptic examination and were given self-management advice and education for their condition. Patients were either discharged, reviewed when over 12 months old, or referred to the consultant for surgery at their first appointment if appropriate.
68% (34) of the patients were managed conservatively and discharged directly from the ERC after the first or second consultation. 32% (16) of patients were listed directly for surgical invention. 100% of the patients reviewed in the ERC were seen to be managed appropriately.
The ERC ensured patients were seen by an appropriate clinician in a timely manner which not only enhanced their experience but also provided the service efficiency by saving consultant clinical time.
The use of the ERC would appear to be an effective and more efficient way to manage patients with NLDO.