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

Eye volume 39, pages 1817–1824 (2025)Cite this article

Subjects

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.

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Fig. 1: Flowchart of the selection of study participants.
Fig. 2: Kaplan-Meier curves showing cumulative incidence of PANDO between the GERD and control group.

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Data availability

The TriNetX platform is a fully deidentified multinational, cloud-based database that adheres to all the relevant adheres to all standards laid out by Section §164,514(b) (1) of the Health Insurance Portability and Accountability Act (HIPPA) as well as ISO 27001:2013. Due to privacy restrictions, data from the TriNetX database is not publicly available. However, the population-level aggregate and deidentified data supporting the findings of this study are openly accessible upon reasonable request to the TriNetX administrators through their website (https://trinetx.com/) or by contacting the TriNetX administrators directly (Privacy@TriNetX.com). Alternatively, the corresponding author may also be contacted (k2001621@gmail.com and b101090109@tmu.edu.tw).

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan

    Yung-Yu Chu, Shu-Chun Kuo, Po-Yu Lee & Yu-Shiuan Lin

  2. Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan

    Chung-Han Ho & Yi-Chen Chen

  3. Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan

    Chung-Han Ho

  4. Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan

    Shu-Chun Kuo

Authors
  1. Yung-Yu Chu
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  2. Chung-Han Ho
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  6. Yu-Shiuan Lin
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Contributions

Y-YC and Y-SL had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Conceptualization: Y-YC, Y-SL; Methodology: Y-YC, C-HH, Y-CC, Y-SL; Formal analysis and investigation: Y-YC, C-HH, Y-CC; Writing—original draft preparation: Y-YC, Y-SL; Writing—review and editing: Y-YC, Y-SL, C-HH, Y-CC, S-CK, P-YL.

Corresponding authors

Correspondence to Po-Yu Lee or Yu-Shiuan Lin.

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The authors declare no competing interests.

Ethics approval

This study was approved by the Institutional Review Board of the Chi Mei Medical Center and conducted under the principles of the Declaration of Helsinki (approval number: 11210-E02).

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The necessity for obtaining informed consent was exempted given that the study was based exclusively on aggregated data and statistical summaries derived from de-identified information.

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Chu, YY., Ho, CH., Chen, YC. et al. Risk of primary acquired nasolacrimal duct obstruction among gastroesophageal reflux disease patients: a global population-based study. Eye 39, 1817–1824 (2025). https://doi.org/10.1038/s41433-025-03759-5

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