Superior lacrimal canalicular atresia and nasolacrimal duct obstruction in the CHARGE association

Syndromic and Nonsyndromic Systemic Associations of Congenital Lacrimal Drainage Anomalies: A Major Review

PURPOSE

To review and summarize the syndromic, nonsyndromic, and systemic associations of congenital lacrimal drainage anomalies.

METHODS

The authors performed a PubMed search of all articles published in English on congenital lacrimal anomalies (1933-2016). Patients of these articles were reviewed along with the literature of direct references to syndromes and other systemic associations. Data reviewed included syndromic descriptions, systemic details, demographics, lacrimal presentations, management, and outcomes.

RESULTS

Syndromic and systemic associations with congenital lacrimal drainage disorders are not known to be common. Although familial presentations have been reported, the inheritance patterns are unclear for most anomalies. There is an increasingly growing evidence of a genetic basis to many lacrimal anomalies. However, few syndromes have either widespread or are frequently associated with lacrimal anomalies. Few sequences of distinct lacrimal presentations and intraoperative findings are seen. Surgical challenges in these patients are distinct and a thorough pre and intraoperative anatomical assessment, detailed imaging when indicated, and assessment and correction of associated periocular and facial abnormalities may facilitate good outcomes.

CONCLUSIONS

Lacrimal drainage anomalies associated with syndromic and nonsyndromic systemic conditions have certain unique features of their own and their surgical and anesthesia challenges are distinct. Diagnosis of congenital lacrimal drainage anomalies should prompt consideration of the possible presence of associated systemic abnormalities.

Canalicular wall dysgenesis: the clinical profile of canalicular hypoplasia and aplasia, associated systemic and lacrimal anomalies, and clinical implications

PURPOSE

To report the clinical and diagnostic profile of canalicular wall dysgenesis (CWD), associated systemic and lacrimal anomalies and to propose its classification.

METHODS

Prospective interventional study involving 7 dysgenetic canaliculi of 7 consecutive patients seen between June 2010 and July 2012. Data collected include demographics, clinical presentation, laterality, age at presentation, duration of symptoms, slit-lamp examination, punctal profiles, types of canalicular dysgenesis, wall involvement details, associated systemic and lacrimal anomalies, family history, and management modalities. CWD and its components were defined along with their clinical features.

RESULTS

The patients included were 5 men and 2 women, with a mean age of 5.8 years (range 2-12 years) at presentation. All patients had unilateral and single canalicular involvement. Epiphora was the most common complaint noted in all the patients, and the symptoms were noticed since birth in 85.7% (6/7). The right eye was involved in 85.7% (6/7) and lower canaliculi were involved in 57.1% (4/7) of the cases. Isolated single wall dysgenesis involving only the roof was noted in 71.4% (5/7), with hypoplasia being the common form seen in 57.1% (4/7). Associated lacrimal anomalies were seen in all and systemic anomalies were noted in 28.5% (2/7) of the patients.

CONCLUSIONS

This study exclusively describes the clinical profile of CWD and proposes a classification. Single or multiple canalicular wall hypoplasia and aplasia are probably better terms to use, and this study could be the beginning for further investigations into the embryogenesis and genetics of this intriguing congenital disorder.

Lacrimal outflow dysgenesis

PURPOSE

To evaluate patients with lacrimal dysgenesis.

DESIGN

Retrospective, nonrandomized, comparative case series.

PARTICIPANTS

Fifty patients with lacrimal dysgenesis managed between 1992 and 2003. TESTING/INTERVENTION: The diagnosis of lacrimal outflow dysgenesis was made based on the following criteria: absent or hypoplastic punctum, canaliculus, lacrimal sac, and nasolacrimal duct, appearing in isolation or combination. Our management algorithm included observation, punctoplasty with intubation, or open lacrimal surgery, with or without intubation.

MAIN OUTCOME MEASURE

Success, partial success, or failure of treatment.

RESULTS

Lacrimal dysgenesis in our 50 patients (23 male and 27 female) involved 83 eyes, distributed as follows: proximal in 74 eyes (89%), distal in 27 (33%), and both in 18 (22%). Thirty (60%) patients presented with isolated lacrimal dysgenesis, and 20 (40%) presented with a systemic syndrome or dysmorphism. Thirty-three (66%) patients had bilateral involvement. Epiphora was the most common presenting symptom. Eighteen (36%) patients had a positive family history. Open lacrimal surgery was performed in a total of 29 (35%) of the 83 eyes: 25 had success, 3 had partial success, and 1 had failure.

CONCLUSION

Both sporadic and hereditary forms of lacrimal outflow dysgenesis may present as an isolated finding or a part of a systemic syndrome or dysmorphism, occurring usually with bilateral involvement and presenting at a younger age in the setting of systemic anomalies. Proximal and distal lacrimal outflow systems may be involved with epiphora as the most common presenting symptom. The algorithm we have presented provides a systematic approach to the management of lacrimal outflow dysgenesis.