Prevalence of amblyopia in children undergoing nasolacrimal duct irrigation and probing

Anisometropia and refractive status in children with congenital nasolacrimal duct obstruction-a prospective observational study

PURPOSE

To assess the refractive status and anisometropia in children with unilateral and bilateral congenital nasolacrimal duct obstruction (CNLDO).

METHODS

Consecutive children newly diagnosed with CNLDO were prospectively enrolled from November 2017 to May 2019. A complete ophthalmic evaluation including cycloplegic refraction was performed followed by appropriate intervention. Patients were followed for 6 months, and cycloplegic refraction was performed at each visit. The final refractive error was defined as the refractive error obtained from the most recent visit. Amblyogenic risk factors were assessed based on 2013 referral criteria of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS).

RESULTS

A total of 308 patients with CNLDO were enrolled: 205 (67%) unilateral cases and 103 (33%) bilateral cases. In unilateral cases, the affected eye and unaffected fellow eye showed statistically significant difference in terms of sphere (P < 0.001), cylinder (P = 0.019), and spherical equivalent (P < 0.001); there was no interocular difference in bilateral cases (P > 0.05). Anisometropia was more prevalent in unilateral cases than in bilateral cases (11.2% vs 1.9%; P = 0.005). Based on the 2013 AAPOS referral criteria, 3.9% of the unilateral and 3.9% of bilateral cases exhibited amblyogenic risk factors. Later age of presentation was associated with higher rate of anisometropia (53.8% in the age group >48 months).

CONCLUSIONS

In our study cohort, unilateral CNLDO was associated with a higher prevalence of anisometropia compared with bilateral CNLDO. The affected eye in unilateral CNLDO had higher prevalence of refractive error.

Success rates of probing for congenital nasolacrimal duct obstruction at various ages

BACKGROUND

Although nasolacrimal duct probing is the standard treatment for congenital nasolacrimal duct obstruction (CNLDO) among children, the optimal timing of this procedure has been a topic of debate. The aim of the study was to analyze the clinical efficacy of nasolacrimal duct probing among patients with CNLDO symptoms at various ages.

METHODS

An 8-year retrospective study involved 2434 patients (3009 eyes), who underwent nasolacrimal duct probing conducted under topical anesthesia in the operating theatre. The study group consisted of 1148 girls (47.2%) and 1286 boys (52.8%) from 2 weeks to 41 months (average age was 8 ± 5.6 months). The participants were divided into nine age groups: 0-2 months, 3-6 months, 7-9 months, 10-12 months, 13-15 months, 16-18 months, 19-21 months, 22-24 months and over 24 months.

RESULTS

Bilateral obstruction was present among 575 (23.6%) children and was associated with a higher percentage of unsuccessful procedures compared to patients with unilateral obstruction (16.9% vs 10.2%, p < 0.001 Chi-square test). The success rate of the initial probing was 87.2% for all children and it was shown that it decreased with age. In the above age groups, it was 87.9%; 91.4%; 89.6%; 86%; 76.3%; 71.3%; 70.3%; 70.2%; 65.4%, respectively.

CONCLUSIONS

Probing is a safe and effective procedure. However, age at the time of the initial intervention and bilateral surgery constitute significant risk factors for failed probing. Probing between 7 and 9 months appears to be reasonable treatment strategy for children without recurrent infections. Early surgical intervention may be considered for patients with additional signs.

Prevalence and Treatment Outcome of Nasolacrimal Duct Obstruction in Saudi Children with Down Syndrome

Introduction

Congenital nasolacrimal duct obstruction (CNLDO) is one of the most common congenital abnormalities encountered by pediatric ophthalmologists, occurring in 20-30% of all neonates (range: 6-84%). The majority of the cases (up to 90%) resolve within the first year of birth. Many syndromes, such as Down syndrome, are associated with congenital lacrimal anomalies. The prevalence of nasolacrimal anomalies in Down syndrome has been reported to be 22%.

Methods

This was a retrospective study of all children diagnosed with Down syndrome at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia between 2010 and 2015.

Result

The total sample size was 175 patients; 15 patients were diagnosed with CNLDO with a prevalence of 8.57%. The prevalence among the gender was 53.3% male and 46.7% female, with a median age of eight years. Regarding ocular disorders, 20.0% cases were diagnosed with refractive error, 13.3% with nystagmus, and 13.3% with blepharitis. Myopia, strabismus, conjunctivitis, and cataract were observed in four different patients, and the remaining four cases reported no other ocular disorders. Tearing, alone or associated with other symptoms, was the main presentation of CNLDO (86.7%). Bilateral CNLDO was the most commonly observed abnormality, alone or associated with others. The median age at diagnosis was one year. Of the cases, 53.3% were treated medically, 26.7% by surgical correction, and 13.3% required both.

Conclusion

Bilateral CNLDO is the most observed disease pattern among children with Down syndrome. In our study, tearing was the most common clinical presentation and most cases were treated medically. Down syndrome patients should be carefully examined for nasolacrimal duct obstructions and treated medically.

Amblyopia Risk Factors in Newborns With Congenital Nasolacrimal Duct Obstruction

PURPOSE

To investigate the presence of amblyopia risk factors in newborns with congenital nasolacrimal duct obstruction (CNLDO) and age-matched healthy control subjects.

METHODS

This retrospective case-control study involved newborns aged 30 to 60 days with CNLDO and age-matched healthy control subjects. Amblyopia risk factors were identified in accordance with the American Association for Pediatric Ophthalmology and Strabismus Vision Screening Committee recommendations. The prevalence of amblyopia risk factors was compared in newborns with CNLDO and age-matched healthy control subjects, newborns with unilateral and bilateral CNLDO, and the affected eye and fellow eye of newborns with unilateral CNLDO.

RESULTS

Amblyopia risk factors were found in 18 patients (11.9%) with CNLDO and 19 control subjects (8.7%) (P = .314). Eyes with CNLDO showed a significantly lower spherical equivalent compared to control eyes (2.01 ± 1.21 vs 2.79 ± 1.14 diopters, P < .001). No difference in amblyopia risk factors was found in eyes with unilateral and bilateral CNLDO (11.5% vs 12.1%; P = .908) or in eyes with unilateral CNLDO and fellow eyes (9.8% vs 12.3%; P = .540).

CONCLUSIONS

CNLDO does not seem to be associated with amblyopia risk factors in newborns. Because anisometropia might develop later on, all patients with CNLDO should be monitored for amblyopia. [J Pediatr Ophthalmol Strabismus. 2020;57(1):39-43.].

Unilateral congenital nasolacrimal duct obstruction and amblyopia risk factors

Introduction

This study aimed to investigate the prevalence of amblyopia risk factors in patients with unilateral congenital nasolacrimal duct obstruction (CNLDO).

Patients and methods

A retrospective interventional case series was performed on all consecutive patients of unilateral CNLDO who underwent probing over a 6-month period in 2017. All patients underwent a complete ocular examination, retinoscopy, axial length measurements and keratometry. Risk factors for amblyopia were noted based on the American Association for Pediatric Ophthalmology and Strabismus guidelines. The fellow eye of the patients with CNLDO was taken as an internal control. Statistical analysis was performed using Stata version 13.0 statistical software. A p-value of ≤0.05 was considered statistically significant.

Results

One hundred eyes of 50 patients were studied. The median age at presentation was 36 months without any gender predisposition (M: 26, F: 24). All patients presented with symptoms of epiphora. Seven (14%) of the patients were noted to have amblyopia risk factors: five (10%) were secondary to refractive errors and two (4%) had congenital cataracts. The anisometropia noted in the five patients showed the worse eye to be the one with CNLDO in all the cases. The common refractive error noted was a compound hyperopic astigmatism in three eyes followed by mixed astigmatism and simple hyperopia in one eye each.

Conclusion

The prevalence of amblyopia risk factors in children with unilateral CNLDO is marginally higher than that reported in general population. Hence, a thorough evaluation should be carried out to detect amblyopia risk factors and for their prompt management.

Anisometropia and refractive status in children with unilateral congenital nasolacrimal duct obstruction

OBJECTIVE:

The objective of the study was to evaluate the refractive status and thereby assess anisometropia in children with unilateral congenital nasolacrimal duct obstruction (CNLDO).

STUDY DESIGN:

This study design was a descriptive cross-sectional study.

PLACE AND DURATION:

this study was conducted at the Department of Pediatric Ophthalmology and Strabismology, Al-Shifa Trust Eye Hospital, Rawalpindi; from August 2013 to July 2014.

METHODOLOGY:

This study assessed consecutive children with unilateral CNLDO. Cycloplegic refraction on all children with CNLDO was performed followed by appropriate intervention. Refractive errors of the affected and normal eyes were compared.

RESULTS:

One hundred and twenty-four children with a mean age of 29.69 ± 21.12 months (range, 2 months to 8 years) were studied. Based on spherical equivalent (SE), hypermetropia was more common in the affected eyes (P < 0.001). Anisometropia of >1.5 diopters (D) was present in n = 17 (13.7%). Interocular difference was significant for spherical error and SE (P < 0.001) but not cylindrical errors.

CONCLUSION:

Unilateral CNLDO is associated with statistically significant anisometropia, especially anisohypermetropia which has amblyogenic potential. It is vital to perform cycloplegic refraction routinely and counsel parents regarding prognosis and regular follow-ups.