Developmental anomalies of the nasolacrimal system were detected rather less commonly in microphthalmos patients (see Fig. 7.5 for details).

7.4Discussion

7.4.1Patients

With 40 boys and 35 girls, the male–female distribution of the patient sample in this study showed a slight overrepresentation of males, somewhat in excess of the normal boy-to-girl ratio (approximately 108:100) in newborns. Unilateral anophthalmos (38 patients) was present almost twice as commonly as bilateral anophthalmos (20 patients). With a single exception, the 17 patients with microphthalmos all showed unilateral pathology.

There are only a small number of publications dealing systematically with investigations in a comparably large group of patients with congenital anophthalmos. The definitive article published by Collin’s group [23] studied a comparable population in terms of patient numbers, gender, and sample breakdown. However, that study included almost twice as many microphthalmos patients as anophthalmos patients, and this is a marked departure from the population described here, in which 3.4 times as many anophthalmos as microphthalmos patients were

treated. It is likely that patients with microphthalmos were managed better elsewhere with conformers or prostheses than those with clinical anophthalmos and therefore were not referred to us in Rostock for expander therapy; this theory would explain their marked relative underrepresentation.

It is noteworthy that in unilateral disease anophthalmos was encountered about 50% more often on the right side (n = 32) than on the left (n = 22). In microphthalmos, the right-to-left ratio was balanced (n = 8:8). There is no known—or published—explanation for this.

Summary for the Clinician

■Male–female distribution is almost balanced. It is not known why anophthalmos involves the right eye 1.5 times more often than the left eye.

7.4.2Obstetric and Family History

The obstetric course was unremarkable for all children. There was no direct relationship between obstetric history and anophthalmos/microphthalmos. A history of abnormalities during pregnancy was reported for 11 of the 75 mothers. It has been suggested that the factors most likely to be implicated in the etiology are maternal