Associated morbidity of nasolacrimal duct obstruction - A large community based case-control study

Background: To evaluate the prevalence and risk factors of various conditions among patients with nasolacrimal duct obstruction (NLDO). Methods: A retrospective, observational case control study of 2,615 patients diagnosed with NLDO in the Central District of Clalit Health Services HMO in Israel, from 2003 to 2012; 15,650 control patients were randomly selected from the district HMO members. Medical and socio-demographic information were extracted from patients' electronic medical records. The prevalence of various ocular and systemic conditions as risk factors for NLDO was calculated. Results: The average age of NLDO patients was 68.3 ± 14.9 years, 34.4 % were male. Age (p < 0.001), ischemic heart disease (OR = 1.29; CI: 1.15-1.44), glaucoma (OR = 1.17; CI: 1.01-1.36), allergic conjunctivitis (OR = 3.59; CI: 3.28-3.94), dry eye (OR = 1.43; CI: 1.31-1.58), epiphora (OR = 6.34; CI: 5.09-7.91), and allergic rhinitis (OR = 1.51; CI: 1.33-1.71) were significantly associated with NLDO. Smoking (OR = 0.86; CI: 0.77-0.96) was significantly less prevalent among NLDO patients. Conclusions: The etiology of NLDO is multifactorial. The prevalence of associated demographic, systemic, and periocular conditions varies. A better understanding of the patho-physiological association between these factors and NLDO may help its prevention and treatment.