Unilateral CNLDO is associated with statistically significant anisometropia compared to bilateral CNLDO, which predisposes children with unilateral CNLDO to amblyopia. It is vital to perform cycloplegic refraction routinely and counsel parents regarding regular follow-ups. [J Pediatr Ophthalmol Strabismus. 2016;53(3):168-172.].

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.

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Congenital nasolacrimal duct obstruction (CNLDO), previously considered a benign disease, affects 20% of the children globally. It is described by a collection of symptoms in which continuous epiphora and intermittent discharge are present in either one or both the eyes. CNLDO usually resolves in most healthy infants in the first few couple of months; however, it may persist for a number of years in some children. There has been a lot of recent deliberation on how a constant watery eye affects the visual development during the phase of emmetropization in children. A connection between CNLDO and anisometropia has been hypothesized. Multiple factors which include developmental and environmental aspects are thought to play a contributory role in the development of anisometropia by and large; particularly hypermetropic anisometropia, raising the chances of developing amblyopia in children with CNLDO. Published literature on CNLDO had shown inconclusive evidence on this anecdotal propinquity. This chapter discusses CNLDO; etiology, pathogenesis, treatment modalities, surgical intervention, and its role in inducing refractive errors; and its propensity to cause amblyopia.