Prevalence of amblyopia in children undergoing nasolacrimal duct irrigation and probing

Abstract

Purpose:To investigate ambylopia and amblyopia risk factors of children who underwent nasolacrimal duct (NLD) irrigation and probing for congenital nasolacrimal duct obstruction (CNLDO).Materials and Methods:The medical records of patients who had undergone NLD irrigation and probing for CNLDO at an age of 3 years or younger were reviewed, and 51 of the patients were recalled between October 1 and December 31, 2011 for a detailed ophthalmic examination to determinate amblyopia or amblyopia risk factors. Amblyopia was accepted as difference in visual acuity of two or more Snellen lines between the two eyes or visual acuity of 20/30 or worse in either eye.Results:The median age of the 51 patients to whom NLD irrigation and probing were attempted for CNLDO was 23 months. CNLDO affected a total of 70 eyes. All patients were reviewed for best-corrected visual acuity, refractive errors, and strabismus at a median age of 70.5 months (range 31-95 months). Amblyopia or amblyopia risk factors were identified in 14 patients (27.5%). One child (7.15%) had only strabismus, six children (42.8%) had only amblyogenic refractive errors, two (14.3%) had a combination of two, one child (7.15%) had a family history for amblyopia, but four children (28.6%) had no amblyopia risk factors but had amblyopia.Conclusion:Amblyogenic risk factors are found higher in patients with CNLDO and patients undergoing NLD irrigation and probing in comparison to normal population. Therefore, we recommend these children to routinely undergo cycloplegic refractions and full ophthalmic examinations.

Unilateral congenital nasolacrimal duct obstruction and amblyopia risk factors

“…Ramkumar et al 8 studied 142 children with CNLDO and reported the prevalence of amblyopia risk factors in 20% (n=28). Similarly, Ozgur et al 9 reported amblyopia risk factors in 27.5% (n=14) among their cohort of 51 patients, and Kim et al 10 reported the risk factors in 35% (n=9) among their cohort of 26 patients. Siddiqui et al 11 studied 161 patients of CNLDO and reported a statistically significant higher incidence of refractive errors in patients with unilateral CNLDO as compared to bilateral cases.…”

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

“…Bilateral obstruction, occurring in 9–47.5% [ 3 , 4 , 9 , 11 , 18 – 20 , 23 , 26 – 29 , 31 , 33 , 34 , 36 , 38 – 40 ] may indicate a more complicated cause of the condition, create greater technical difficulties during procedures performed under local anesthesia, and thus affect the obtainment of less-satisfactory results, which is also confirmed by our study and reports by other researchers [ 20 , 36 ]. Dietze et al [ 43 ] suggest that patients with trisomy 21, allergic rhinitis/seasonal allergies, history of an upper respiratory tract infection within 1 month and obstructive sleep apnea may be correlated with a higher risk of failure with a probing.…”

“…Abundant lacrimal meniscus and mucopurulent discharge which persists on the surface of the cornea may lead to blurring of vision and interferes with the clear focusing of images on the retina, which is critical for emmetropization [22]. Several authors have confirmed an increased risk for anisometropia and amblyopia in patients with CNLDO (especially long-term untreated obstructions) [22][23][24][25]. However, the effect of long-term epiphora on visual development in children is debatable and some studies reported no significant differences between children with CNLDO and general population [17,26,27].…”

Congenital Nasolacrimal Duct Obstruction and the Visual System

“…It is also proposed that this anisometropia is refractory. However, recent studies reveal that this is not necessarily true [51], which will be discussed in a while.…”

“…The prevalence of anisometropia in the general pediatric population ranges from 2.3 to 3.4%, based on literature review [58]. Amblyopia has been reported to occur in approximately 1.6-3.6% of the normal population [51,58]. The prevalence is even higher in medically underserved populations with reported rate as high as 22.7% [59].…”