Balancing early and late surgical intervention for congenital nasolacrimal duct obstruction
Reviewed by Lucy Osborne

This retrospective study investigated the incidence of anisometropia and amblyopia by age of congenital nasolacrimal duct obstruction (CNLDO) resolution. At Seattle children’s hospital, between 2007 and 2017, the outcomes of children with early versus late spontaneous resolution of CNLDO were compared. All children diagnosed with CNLDO between 1 January 2007 and 1 January 2017 were identified for analysis using ICD-9 and ICD-10 codes. Patients were included if they were diagnosed after nine months of age and had a diagnosis of CNLDO without previous surgery. Patients were excluded if, 12 months following diagnosis, they were unaccounted for. Early spontaneous resolution was defined as complete resolution without intervention before 12 months of age. Late spontaneous resolution was defined as complete resolution without intervention at 12 months of age or above. Anisometropia was defined as a difference of one or greater dioptres between eyes, measured at the last visit. Amblyopia was defined as a difference in visual acuity of two or more lines on Snellen or Allen figure testing, or 0.2 or greater on logMAR. Nonparametric statistical tests were used to compare age at surgery or spontaneous resolution in both groups. All other analyses used Fisher and Mann-Whitney U tests, using SAS / STAT software. Four hundred and sixty-two patients were analysed. Thirty-three percent were classed as the ‘early group’, who experienced either early spontaneous resolution or early surgical intervention. Sixty-seven percent were classed as the ‘late group’, who experienced either late spontaneous resolution, late surgical intervention, or persistent symptom burden without surgical intervention. The rates of anisometropia were 12% in the early group, and 10% in the late group (p=0.686). The rates of amblyopia were 3% in the early group, and 5% in the late group (p=0.322). Among the patients who had symptoms beyond 12 months of age without surgical intervention before 24 months of age, 76% experienced spontaneous resolution of symptoms before 24 months. This retrospective study supports the motion that surgical intervention of CNLDO can be delayed due to the high chance of spontaneous resolution and similar risks of anisometropia and amblyopia but must be balanced alongside symptom burden.

Anisometropia and amblyopia outcomes in early versus late resolution of congenital nasolacrimal duct obstruction in older infants.
Sims DT, Gillette TB, Lam JG, et al.
OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY
2024;40(1):39–42.