Classification of Lacrimal Punctal Stenosis and Its Related Histopathological Feature in Patients with Epiphora

Abstract

PurposeTo evaluate the classification of punctal stenosis based on the shape of the external punctum, clinical characteristics and histopathologic features.MethodsPatients who experienced tearing and were diagnosed with punctal stenosis were evaluated in this study. Punctal stenosis was classified according to the shape of the lower external punctum, which included membranous type, slit type, horseshoe type, and pinpoint type. Tear meniscus height, 2% fluorescein dye disappearance test and lacrimal pathway irrigation were measured or performed. For treatment, a punctal snip operation and silicone tube placement were performed, and the peripunctal histopathological findings were evaluated.ResultsPunctal stenosis was classified into four types: membranous type (17 eyes, 21.5%), slit type (11 eyes, 13.9%), horseshoe type (25 eyes, 31.6%), and pinpoint type (26 eyes, 32.9%). The tear meniscus was significantly higher, and the 2% fluorescein dye disappeared significantly more slowly in the punctal stenosis group. However, correlation of the tear meniscus height and 2% fluorescein dye disappearance test with the punctum shape was not statistically significant. A history of previous chemotherapy was significantly associated with the occurrence of punctal stenosis, especially the membranous type (p < 0.05). Histopathologic evaluation of the punctum showed differences between the punctum types. Pinpoint puncta exhibited a high density of muscle fibers, while they were faintly visible in the membranous type.ConclusionsAcquired punctal stenosis has various shapes, and the major types of stenotic puncta exhibited unique histopathologic features. Punctal stenosis and its pathophysiology may be related to multiple factors, such as age and systemic 5-fluorouracil chemotherapy history.

Evaluation of acquired punctal stenosis using anterior segment optical coherence tomography

“…These different shapes exhibit definite differences in size, with a particularly wide range present regarding external punctal diameter size. 17 Also, the wide age range in the current study may be a contributing factor to the external punctal size variability. The inclusion of patients of older ages should be considered, as older age has been reported by some previous studies to be an etiological factor for punctal stenosis.…”

“…A wide range of external punctal diameter in cases of punctal stenosis may be due to variability in the shape of the external punctum, where each shape has its own character. Hur et al 17 classified punctal stenosis shapes into the following types: membranous, slit, horseshoe and pinpoint, depending on the shape of the external punctum opening. These different shapes exhibit definite differences in size, with a particularly wide range present regarding external punctal diameter size.…”

Three-snip punctoplasty versus perforated plugs for management of lacrimal punctal stenosis

“…Hur et al. 14 classified the grade of punctal stenosis, according to punctal morphology, into four types including membranous, slit, horseshoe, and pinpoint variants. In this study, the classification of Ozgur et al.…”

<p>Anterior Segment Optical Coherence Tomography (AS-OCT) Guided Reversal of Edematous Punctal Occlusion</p>

“…Both are wellknown predisposing factors of punctal stenosis combined with inflammatory and fibrotic changes in the lining epithelium and stroma of the punctum. 1,14,15 Both medical and surgical treatment methods have been used for treatment of punctal stenosis. In this study, we used preservative-free steroid eye drops to benefit from its anti-inflammatory effect and to avoid the toxic effect of the preservatives on the ocular surface.…”

“…Anatomically, acquired punctal stenosis is a condition in which the external opening of the lacrimal canaliculus is narrowed or occluded and also can be accompanied by canalicular ductal stenosis. 1,2 . Defining an anatomical clear cut-off value for punctal stenosis is difficult due to wide variations in patients' demographics.…”