7.5 Conclusions

these occlusions. Obstruction of the valve of Hasner, otherwise typical in this age group [12], played only a minor role in our patients even though the incidence of 8% was approximately consistent with the incidence for this age group, which is reported in the literature to be as high as 15% [14, 15, 17].

In 1887, Collins [4] supplemented the 30 anophthalmos cases published in the literature up to that time with 12 new cases and pointed out the occasional absence of the lacrimal puncta and canaliculi. The lacrimal puncta were always present in our patients.

To date, there have been no comprehensive newer studies of the nasolacrimal duct system in anophthalmos. One case report has described an association between congenital stenosis of the valve of Hasner and congenital anophthalmos [16], but the results presented in our study suggest that this is rather the exception.

So far, the high incidence of nasolacrimal duct anomalies has therapeutic implications only when there is classic congenital stenosis of the valve of Hasner that is successfully corrected in the course of diagnostic probing. Bearing in mind the possible presence of a pathogen reservoir, elimination of the obstruction should be performed so expander therapy is not jeopardized by infec- tion-related complications. However, the vast majority (91.3%) of all stenoses were diagnosed in presaccal locations; because the development of inflammation is not to be expected, surgical management is indicated here only in troublesome epiphora [20].

Summary for the Clinician

■Treatment appears to be necessary only in “classic” congenital stenosis.

7.5Conclusions

If pathology is unilateral, patients with anophthalmos have a poorer prognosis than those with microphthalmos in terms of the potential visual capacity of the fellow eye. The consequence arising from the high incidence of associated developmental anomalies of the fellow eye is that a thorough ophthalmological examination must be a sine qua non for all affected children.

Anophthalmos is also a poorer prognostic factor than microphthalmos in terms of its association with a wide range of systemic diseases. Patients with unilateral anophthalmos tend to display ipsilateral facial anomalies, whereas patients with bilateral anophthalmos are characterized mainly by intracranial anomalies. The consequence must be that every affected child should undergo a meticulous program of pediatric diagnosis that also includes neuroradiological examination.

Because causal therapy is often not available, the recording of all findings enables a reliable prognosis to be established and, if appropriate, permits early initiation of specific measures to promote visual acuity.

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