Anisometropia and amblyopia in nasolacrimal duct obstruction

Abstract

IntroductionChildhood nasolacrimal duct obstruction (NLDO) has long been considered to be a benign condition which does not affect vision development. Recent studies have suggested an association between NLDO and amblyopia.MethodsA retrospective review was conducted of 1,218 patients between ages of birth to six years with diagnosis of nasolacrimal duct obstruction (NLDO) from 2000-2010. Data collected included onset of NLDO, laterality of NLDO, cycloplegic refractive error, determination of clinically significant anisometropia (defined as ≥ 1 D), and diagnosis of amblyopia with amblyopia sub-type (anisometropic vs other).Results887/1218 (72.8%) had unilateral NLDO. Anisometropia was found in 79/1218 (6.5%) patients on initial examination; an additional 26 patients developed anisometropia on follow-up examination for a total of 105/1218 (8.6%). A significant association between same sided unilateral NLDO and higher hyperopia in the anisometropia patients (2= 33.01, P < 0.001) was found on initial examination. Follow-up data of 482 patients showed 28 (5.8%) developed amblyopia, 16 of which were due purely to anisometropia.DiscussionUnilateral NLDO appears to be associated with anisometropia. The incidence of anisometropia (8.6%), amblyopia (5.8%) and anisometropic amblyopia (3.3%) in this large NLDO cohort exceeds that found in the general pediatric population. No cause–effect relationship could be established in this retrospective study.ConclusionsMeasurement of cycloplegic refraction and periodic follow-up of children diagnosed with NLDO is warranted. Future prospective studies could elucidate any benefit to early spontaneous resolution or surgical intervention. IntroductionChildhood nasolacrimal duct obstruction (NLDO) has long been considered to be a benign condition which does not affect vision development. Recent studies have suggested an association between NLDO and amblyopia. Childhood nasolacrimal duct obstruction (NLDO) has long been considered to be a benign condition which does not affect vision development. Recent studies have suggested an association between NLDO and amblyopia. MethodsA retrospective review was conducted of 1,218 patients between ages of birth to six years with diagnosis of nasolacrimal duct obstruction (NLDO) from 2000-2010. Data collected included onset of NLDO, laterality of NLDO, cycloplegic refractive error, determination of clinically significant anisometropia (defined as ≥ 1 D), and diagnosis of amblyopia with amblyopia sub-type (anisometropic vs other). A retrospective review was conducted of 1,218 patients between ages of birth to six years with diagnosis of nasolacrimal duct obstruction (NLDO) from 2000-2010. Data collected included onset of NLDO, laterality of NLDO, cycloplegic refractive error, determination of clinically significant anisometropia (defined as ≥ 1 D), and diagnosis of amblyopia with amblyopia sub-type (anisometropic vs other). Results887/1218 (72.8%) had unilateral NLDO. Anisometropia was found in 79/1218 (6.5%) patients on initial examination; an additional 26 patients developed anisometropia on follow-up examination for a total of 105/1218 (8.6%). A significant association between same sided unilateral NLDO and higher hyperopia in the anisometropia patients (2= 33.01, P < 0.001) was found on initial examination. Follow-up data of 482 patients showed 28 (5.8%) developed amblyopia, 16 of which were due purely to anisometropia. 887/1218 (72.8%) had unilateral NLDO. Anisometropia was found in 79/1218 (6.5%) patients on initial examination; an additional 26 patients developed anisometropia on follow-up examination for a total of 105/1218 (8.6%). A significant association between same sided unilateral NLDO and higher hyperopia in the anisometropia patients (2= 33.01, P < 0.001) was found on initial examination. Follow-up data of 482 patients showed 28 (5.8%) developed amblyopia, 16 of which were due purely to anisometropia. DiscussionUnilateral NLDO appears to be associated with anisometropia. The incidence of anisometropia (8.6%), amblyopia (5.8%) and anisometropic amblyopia (3.3%) in this large NLDO cohort exceeds that found in the general pediatric population. No cause–effect relationship could be established in this retrospective study. Unilateral NLDO appears to be associated with anisometropia. The incidence of anisometropia (8.6%), amblyopia (5.8%) and anisometropic amblyopia (3.3%) in this large NLDO cohort exceeds that found in the general pediatric population. No cause–effect relationship could be established in this retrospective study. ConclusionsMeasurement of cycloplegic refraction and periodic follow-up of children diagnosed with NLDO is warranted. Future prospective studies could elucidate any benefit to early spontaneous resolution or surgical intervention. Measurement of cycloplegic refraction and periodic follow-up of children diagnosed with NLDO is warranted. Future prospective studies could elucidate any benefit to early spontaneous resolution or surgical intervention.