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Andrew Mueller, Alice Zhang, Stacy Scofield-Kaplan, Ronald Mancini; Identification of Primary Acquired Nasolacrimal Duct Obstruction Risk Factors. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6237.
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© ARVO (1962-2015); The Authors (2016-present)
Primary acquired nasolacrimal duct obstruction (PANDO) is the most common cause of nasolacrimal duct obstruction (NLDO) in adults. The pathogenesis of NLDO has been the focus of many studies and is likely multifactorial with many influencing factors. We performed a retrospective case-control study to identify risk factors that contribute to the pathophysiology and development of PANDO.
In a retrospective, age- and gender-matched case-control study, 105 patients with PANDO undergoing dacryocystorhinostomy (DCR) were compared to 105 control patients with nuclear cataracts in a private ophthalmology clinic of a tertiary medical center between January 2010 and February 2018. The following risk factors were recorded: smoking status, use of vitamin D supplements, osteopenia or osteoporosis, hypothyroidism, hyperlipidemia, allergic rhinitis, blepharitis, conjunctivitis, and use of glaucoma medications. The groups were compared using Pearson’s chi-square test for independence (Χ).
The average age was 62.3 ± 17.1 for the case group (n=105) and 62.5 ± 16.7 for the control group (n=105), with 77.1% female distribution in the case group and 75.2% female in the control group. There was a statistically significant increase in PANDO in those with a history of conjunctivitis (p=0.0053). Factors without a statistically significant difference between groups included smoking (p=0.77), vitamin D2/D3 supplements (p=0.57), osteopenia or osteoporosis (p=0.69), hypothyroidism (p=0.48), hyperlipidemia (p=0.57), allergic rhinitis (p=0.25), blepharitis (p=0.13), and glaucoma medications (p=0.47). The glaucoma medications were analyzed by drug class, including prostaglandin analogs (p=0.27), beta blockers (p=0.84), alpha agonists (p=0.52), and carbonic anhydrase inhibitors (p=0.23), but none were statistically significant.
This study reiterates the middle-to-older age and female predilections for PANDO. There is a statistically significant increase in the development of PANDO in those with a history of conjunctivitis. This association is consistent with prior literature describing chronic inflammation and fibrosis in obstructed nasolacrimal ducts. An additional notable finding is that there is no significant correlation between the development of NLDO and the use of glaucoma medications.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Demographics and risk factors for nasolacrimal obstruction
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