This large global study was predicated on over 157 million patient records worldwide in 18 different countries, and assessed the association between GERD and PANDO. This was a retrospective cohort study with data collected worldwide from the TriNetX Global Collaborative Network. Patients diagnosed with GERD between January 2004 and November 2024 were included in the study along with non GERD controls. To validate results, patients with prior or existing lacrimal passage disorders were excluded. The primary outcome was incidence of PANDO, with follow up of up to 20 years, for each patient and for a specified duration. Lastly, we used propensity score matching to balance baseline characteristics between the patients, and Cox proportional hazards regression to assess the relative risk.
Key Findings
After conducting propensity score matching, 876,330 total patients from both the GERD and control groups were included.
GERD patients were at an increased risk of developing PANDO (HR: 2.49; 95% CI: 2.18–2.85; p< 0.001).
The risk was higher in females (HR: 2.74; 95% CI: 2.32–3.24) and in older individuals aged ≥60 years (HR: 3.12; 95%CI: 2.59–3.74).
Comorbidities including diabetes, dyslipidemia, hypertension, ischemic heart disease, chronic kidney disease, and sinusitis increased the risk of GERD-related PANDO.
The underlying mechanism linking GERD to PANDO is not clear, although chronic inflammation may play a role. Acid reflux has been associated with inflammatory processes beyond the esophagus, which may lead to structural and functional changes in the nasolacrimal duct. Chronic exposure to gastric acid reflux may cause mucosal irritation, tissue remodeling, and fibrosis, thus increasing the risk of ductal obstruction. These findings highlight the need for a higher level of clinical awareness and interprofessional collaboration in the management of GERD patients, focusing on gastrointestinal health and eye health.
Reference:
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 (2025).
https://doi.org/10.1038/s41433-025-03759-5
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