Neonatal dacryostenosis as a risk factor for anisometropia

Objective: To determine whether there is a relationship between congenital nasolacrimal duct obstruction (CNLDO) and subsequent refractive error disorders in children. Methods: The medical records of children 5 years and younger diagnosed as having CNLDO between January 1, 2000, and December 31, 2007, were retrospectively reviewed. Results: Three hundred five consecutive children were diagnosed as having CNLDO at a median age of 12.3 months (range, 0.8 months to 4.8 years). Thirty children (9.8%) were diagnosed as having anisometropia with (n=16) or without (n=14) amblyopia at a median age of 19.2 months (range, 3.6 months to 7.4 years). Twentysix of the 30 patients had hyperopic anisometropia; more severe hyperopia occurred in the eye with CNLDO in 23 patients (88.5%), 2 patients had more severe hyperopia in the fellow eye, and 1 patient had bilateral CNLDO. The median initial (P=.005) and final (P<.001) refractive error was significantly more hyperopic in those with both CNLDO and anisometropia compared with those with CNLDO alone. Conclusions: The development of anisometropia with or without amblyopia seems to be more frequent in children examined by an ophthalmologist for CNLDO compared with that reported for the general public. The laterality of more severe hyperopia and amblyopia is generally on the side of the previous dacryostenosis.