Risk of primary acquired nasolacrimal duct obstruction among gastroesophageal reflux disease patients: a global population-based study.

Abstract

Objectives: The relationship between gastroesophageal reflux disease (GERD) and primary acquired nasolacrimal duct obstruction (PANDO) remains underexplored, and large-scale global studies are lacking. This study aims to evaluate the association between GERD and PANDO on an international scale.

Methods: This retrospective cohort study utilized data from the TriNetX Global Collaborative Network, encompassing over 157 million patients across 18 countries. Patients with GERD and controls without GERD were included from January, 2004, through November, 2024. Patients with pre-existing lacrimal passage disorders were excluded. The primary outcome was the incidence of PANDO. Patients were followed for up to 20 years. Propensity score matching was employed to balance baseline characteristics. Cox proportional hazards regression was used to calculate hazard ratios (HRs), and Kaplan-Meier analysis was conducted to assess the cumulative incidence.

Results: After matching, 876,330 patients were included in both the GERD and control cohorts. GERD was associated with a significantly higher risk of PANDO (HR: 2.49; 95% CI: 2.18-2.85; P < 0.001). Risk stratification analyses demonstrated greater risks in females (HR: 2.74; 95% CI: 2.32-3.24) and in older age groups (HR for ≥60 years: 3.12; 95% CI: 2.59-3.74). Comorbidities such as diabetes, dyslipidaemia, hypertension, ischemic heart disease, chronic kidney disease, and sinusitis further increased the risk of PANDO.

Conclusions: GERD increases the risk of PANDO, particularly in females, older adults, and patients with cardiovascular comorbidities or sinusitis. Clinicians should educate GERD patients about the potential risk of PANDO and arrange referrals when necessary.