الفهرس 
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Abstract
Obstruction of the lacrimal system can occur at any age but it is a particular common pediatric problem. It is one of the most common ocular conditions of infancy. It was found in up to 30 % of infants at birth, but nearly 6 % has symptoms of nasolacrimal duct obstruction, affecting one or both eyes. The most common cause of this critical problem is the failure of a canalization of the duct at its mucosal entrance (valve of Hasner) into the inferior meatus of the nose. ( American Association for Pediatric Ophthalmology and strabismus , 2015; Eric, 2013).
Blockage of the drainage system causes excessive tearing. The eyelids can become red and swollen with yellowish-green discharge. When normal eyelid bacteria are not properly ”flushed” down the obstructed system severe serious infection of the tear duct system (dacryocystitis) will occur .( Paul, 2009; Ghuman, 2015)
When obstruction is persistent, one or more of the following treatments may be recommended: conservative management in the form of tear duct massage with topical antibiotic eye drops, tear duct probing, balloon tear duct dilation, and/or tear duct intubation. It was estimated in previous advanced researches that, conservative management is the best option until the first year of age, and many of the cases respond to conservative treatment with lacrimal sac massage and topical antibiotic drops. Surgical procedure is usually accompanied with risk hazards especially during the first year of life. (Zou, 2009) .
Tear duct massage is considered as a simple technique for care givers and can be performed at home to help the tear duct open. A primary care nurses can demonstrate it to help infants gain its benefits . In a large majority of cases, the cause of failure of conservative treatment is an improper technique of lacrimal sac massage. The technique of massage generally advised to parents did not result in opening up of the duct, with a high rate of probing subsequently. It was related to, most parents were found to massage either at the wrong place or in the wrong direction (Petersen, 2011).
Aim of the study :
The aim of the study was to examine the effectiveness of a primary nursing intervention for infants with congenital nasolacrimal duct obstruction. This aim could be fulfilled through the following objectives, assess mother’s knowledge and practices about CNLDO, plan and implement educational nursing intervention for infant’s mothers about CNLDO to improve their knowledge and their practices to provide the proper care of their infants.
Setting:
The study was conducted in outpatient clinic of Kafr El-Sheikh New Ophthalmology Hospital.
Subjects:
All infants that attends to outpatient clinic and diagnosed with congenital naso-lacrimal duct obstruction ( CNLDO) during the period of data collection ( 4 months) . the total number was n = 460 infants . A purposive sample of infants who met the required inclusion criteria and their mother or father agreed to participate in the study were recruited.
Inclusion criteria:
Age of infant less than one year.
Both sex was chosen.
infants that diagnosed with congenital naso-lacrimal duct
obstruction
The final sample size was 100 infants and their mothers as the cases group and 100 infants and their mothers as the control group.
Tool of Data Collection:
An interviewing questionnaire: (Appendix 1)
This questionnaire was designed and used by the researcher after an extensive review of literature and discussion with the experts to collect data about the subjects .
The questionnaire contains the following parts:
Part l: socio demographic data as :
a. socio demographic data about the infant as name, age and sex.
b. socio demographic data about the mothers and fathers of the child as name, age, address, job and the educational level .
Part 2 : mother’s knowledge and practices about CNLDO
a. Assessment of mother’s knowledge: It included questions to assess mother’s knowledge about nasolacrimal duct obstruction as definition, signs and symptoms, causes, complications and management of CNLDO , this part was used for (pre & post test) .
The total score of each mother was categorized arbitrary into:
1 . Poor knowledge : when the mother achieved less than or equal 50% of the total score
2 . Adequate knowledge : when the mother achieved more than 50% of the total score.
b . Assessment of mother’s practice : It included questions to assess mother’s practice at home as, how many times to perform the nasolacrimal sac massage and the mechanism of massage , eye care , caring of child at fever, using of eye drops (pre & post test).
The total level of mother’s practice was categorized as :
1 . Poor practice : when the mother achieved less than or equal 50% of the total score
2 . good practice : when the mother achieved more than 50% of the total score
Part 3: developed check list to measure the prognoses of the condition through assessment of relieving of signs and symptoms of nasolacrimal duct obstruction(Resolution of CNLDO) .
The nursing intervention :
Nursing intervention plan was developed and implemented by the researcher to cases only based on mother’s knowledge and practices needs. To modify mother’s knowledge and their incorrect practices .
Follow up:
It included follow up using telephone, to inform the effect of the nursing intervention for modifying the incorrect or incomplete practices in caring of the infants with naso lacrimal duct obstruction. In addition , to assess the change of knowledge and answer any question raised by the mothers.
Evaluation phase:
The researcher conduct the post test after 3- 6 months of intervention and compared the result of cases with controls pre and post test to assess the effect of nursing intervention on the prognoses of cases.
The study revealed the following main finding :
According to infant’s age, the study revealed that the prevalence of CNLDO was 61.6% in infants aged 4 to 8 months, while 35.4% in infants aged less than 4 months , and 3% in infants aged 8 to 12 month.
According to the infant’s gender, the study revealed that 42.6% had been female and 57.6 % male.
According to mother age, the study reported that more than half (77.8% ) of the mothers had been between 25 and 40 years old while 15.1% of them aged 18- 25 year and 7.1 % aged more than 40 year.
According to residence, the study revealed that more than half of the studied infants(59.6%) had being from urban while 40% from rural areas.
Concerning the level of mothers education , the study revealed that 74.7 % of them secondary educated mothers, while 4% of mothers can read and write and 21.2% of them had being highly educated.
Regarding to mothers occupation, the study revealed that, more than half (69.7%) of the mothers had being housewife and 30.3% employee.
Regarding to father occupation and smoking status, the study showed that 38.4% had being professionals, 29.3% farmer, 26.3% employee and 6.1% not work. It also showed that 28.3 % had been smokers .
Regarding to pregnancy and obstetric history of the infant’s mothers the study reported that: 92.9% of the mothers had full term baby but 7.1% had incomplete pregnancy. Concerning of type of labor, it showed that 39.4% of the mothers had normal labors while 60.6 % had cesarean section.
Concerning infant’s birth weight, study revealed that 92.9 % of the infants had normal birth weight and 7.1% had been L.B.W.
The study revealed that 91.9% of the studied infants had no family history of CNLDO , but 8.1% had a family history of CNLDO .
Regarding to mother’s knowledge before intervention, this study reported that less than one sixth of the mothers (15.2%) correctly responded to questions about CNLDO , while unfortunately more than eighty percent (84.8%) had inadequate. knowledge. (P=0.02).
The study revealed that, the health educational nursing intervention revealed a high significant improvement(p<0.000) in mothers knowledge and practices about CNLDO in interventional group comparing with the control group.
High significant improvement(p<0.000) in the different components of resolution of CNLDO aspects among intervention group comparing with the control group.
Nursing intervention revealed a high rates of improvement of CNLDO (resolution) in intervention group reached to 85.9 % of cases. there had been higher significant percentages of improvement of infant’s condition among cases comparing with the control group( non-intervention group) which had improvement 58.6 % of infants.
This study concluded that:
The health education intervention for mothers of infants with CNLDO was an effective method for improvement of their knowledge and their practices, and subsequently lead to high rates of resolution of CNLDO
The study recommended that:
The nursing roles should be directed toward educating care givers about proper care for infants with CNLDO, emphasizing the importance of the massage to the mothers (parents) and describing in detail, because this can reduce the risk of unnecessary surgical interventions and its subsequent complications.
Follow up program of the infants with CNLDO should be applied and organized in the hospitals, for the proper conservative management application at home, reliving of the singes and symptoms on the infant, prognosis of CNLDO and any raising problems or complications.
More researches will be needed for training of community health nurses especially the new nurses, about the proper care of congenital nasolacrimal duct obstruction, and improving the awareness of the nurses about the nature of congenital naso-lacrimal duct obstruction(CNLDO), different forms of management, complications, and its prognosis.