Association Between Congenital Nasolacrimal Duct Obstruction and Mode of Delivery
Daniela P. Reyes-Capo, BA; Mehdi Tavakoli, MD; Carla J. Osigian, MD; Catherine J. Choi, MD; Piangporn Saksiriwutto, MD; Elizabeth A. Vanner, PhD; Kara M. Cavuoto, MD; Sara D. Wester, MD
Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
Introduction: Congenital nasolacrimal duct obstruction (CNLDO) is one of the most common ocular disorders in infants and is typically caused by a persistent membrane covering the valve of Hasner (1). During a vaginal delivery (VD) the mechanical forces of the uterus may have a massage effect on the nasolacrimal system, resulting in the opening of Hasner’s valve (2). This study investigates the association between mode of delivery [VD versus cesarean section (CS)] and CNLDO.
Methods: A retrospective chart review of patients with CNLDO evaluated at a tertiary referral center between 2012-2017 was performed. Patient demographics, birth history, clinical characteristics, and treatment outcomes were compared in patients delivered via CS versus VD. Annual rates of CS and prematurity were obtained from the CDC National Center for Health Statistics.
Results: A total of 104 children were included. Mean age at presentation was 9.4 ± 9.2 months for the CS group and 15.7 ± 20.2 for the VD group (p=0.03). A statistically significant higher percentage of patients with CNLDO (61%) were delivered via CS (p<0.0001). The prevalence of prematurity was 26%, significantly higher than the general population (p<0.0001). CNLDO did not resolve spontaneously and surgical intervention was required in 37 CS versus 13 VD patients (P=0.007). Among patients who failed first line probing and required additional interventions, 86.2% were born via CS and 13.8% were born via VD (P=0.0009).
Discussion: CS and prematurity are associated with a higher prevalence of CNLDO.
Conclusion: Children born premature or via CS are at risk for developing a complicated course of CNLDO.
References: 1. Moscato EE, Kelly JP, Weiss A. Developmental anatomy of the nasolacrimal duct: implications for congenital obstruction. Ophthalmology. 2010;117(12):2430-2434.
2. Spaniol K, Stupp T, Melcher C, Beheiri N, Eter N, Prokosch V. Association between congenital nasolacrimal duct obstruction and delivery by cesarean section. Am J Perinatol. 2015;32(3):271-276.