Anisometropia and amblyopia in nasolacrimal duct obstruction

Abstract

To investigate an association of childhood nasolacrimal duct obstruction (NLDO) with anisometropia and amblyopia. The medical records of patients from newborn to 6 years of age with a diagnosis of NLDO seen from 2000 to 2010 were retrospectively reviewed. Data collected included age at onset of NLDO, laterality of NLDO, cycloplegic refractive error, determination of clinically significant anisometropia (defined as ≥1 D), and diagnosis of amblyopia with amblyopia subtype (anisometropic vs other). A total of 1,218 patients with NLDO were included. Of these, 887 cases (72.8%) were unilateral; 331 (27.2%), bilateral. Anisometropia was found in 67 (7.6%) unilateral cases and 12 (3.6 %) bilateral cases on initial examination (χ2=5.48, P < 0.01). Same-sided unilateral NLDO was significantly associated with greater hyperopia in the anisometropia patients (χ(2) = 33.01, P < 0.001). Follow-up data were available for 482 NLDO patients and revealed an additional 26 patients with anisometropia for a total of 105 of 1218 (8.6%). Of the 482 patients, 28 (5.8%) developed amblyopia, 16 cases of which were purely attributable to anisometropia. Of 41 patients with anisometropia who were in the follow-up, 9 (22%) developed amblyopia. Anisometropia occurred at a greater rate in unilateral NLDO patients compared with bilateral NLDO patients and occurred at a greater rate in this NLDO cohort than expected in the general pediatric population. Several patients with anisometropia developed clinical amblyopia. Measurement of cycloplegic refraction in all NLDO patients at initial examination should be considered. Periodic follow-up is appropriate for patients with NLDO and anisometropia.