Down syndrome is a risk factor for developing corneal ulcers following nasolacrimal duct stenting

Nasolacrimal duct stents are often used to treat congenital nasolacrimal duct obstruction (NLDO). Rarely, corneal ulcers may develop following stent placement. Of the 349 monocanalicular stents placed in 253 patients with congenital NLDO over a period of 33 months at our institution, 4 stents (1.1%) resulted in corneal ulcers. Three occurred in children with Down syndrome (n = 35); 1 occurred in a child retroactively diagnosed with neurotrophic keratitis. The 3 cases indicate a statistically significant increased relative risk of corneal ulcer formation in children with Down syndrome compared with the remaining patients (9% vs 0.46%; relative risk = 18.68; P = 0.0102).