title: [Increased prevalence of congenital dacryostenosis following cesarean section].
abstract: BACKGROUND
  Congenital nasolacrimal duct obstruction (dacryostenosis) with a persisting membrane at Hasner's valve is the most common cause of persistent tear and ocular discharge in infants.
  
  
  OBJECTIVE
  To evaluate whether there is an association between congenital dacryostenosis and delivery via cesarean section.
  
  
  METHODS
  In a prospective study we examined 107 children (mean age 9.2 ± 7.1 months) with congenital dacryostenosis. We evaluated data about the mode of delivery (vaginal delivery versus cesarean section) and gestational age at the time of birth. Within the first 8 months of life children were treated by probing using local anesthesia, whereas older children were treated using general anesthesia. After the age of 11 months treatment included nasolacrimal duct intubation with a bicanalicular stent. Statistical analyses were performed using binomial tests, Fisher's exact test and the t-test.
  
  
  RESULTS
  In this study 51 children delivered by cesarean section were compared with 56 children delivered by spontaneous vaginal delivery. A total of 44 age-matched pairs from both groups were evaluated in order to eliminate confounding factors due to gestational age at delivery. Based on the published rate of cesarean sections from the same region of the State of Hesse between 2002-2004 we observed a statistically significant association between congenital dacryostenosis and delivery by cesarean section among the 88 age-matched patients (P = 0.009). Moreover, subgroup analysis revealed a significant association between congenital dacryostenosis and delivery by primary cesarean section (P = 0.00004). The prevalence of surgical treatment was not statistically different between both groups based on the mode of delivery (P = 0.8).
  
  
  CONCLUSIONS
  Our results suggest that delivery via cesarean section is associated with a significantly higher prevalence of congenital dacryostenosis.
authors.affiliation: Klinik für Augenheilkunde, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland. hattenbach@med.uni-frankfurt.de.
authors.forename: Claudia
authors.initials: C
authors.lastname: Kuhli-Hattenbach
authors.affiliation: Klinik für Kinderaugenheilkunde, Schielbehandlung und plastisch-rekonstruktive Lidchirurgie, Bürgerhospital, Frankfurt am Main, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Lüchtenberg
authors.affiliation: Klinik für Augenheilkunde, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Hofmann
authors.affiliation: Klinik für Augenheilkunde, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Kohnen
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D007767:Lacrimal Duct Obstruction / Q000151:congenital* / Q000453:epidemiology*; D008297:Male; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
keywords: Cesarean section; Dacryostenosis; Delivery, obstetric; Gestational age; Infant