Immunopathology and histopathology of conjunctival biopsies in patients with presumed idiopathic punctal stenosis

Reddy, Amit K.; Baker, Meredith S.; Maltry, Amanda C.; Syed, Nasreen A.; Allen, Richard C.

doi:10.1136/bjophthalmol-2015-308291

Cited by 13 publications

(5 citation statements)

References 21 publications

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“…In those studies; specimens from the puncti were examined showing evidence of chronic inflammation in the majority of specimens (83 and 100 % of the cases). In a later published study, 97.2% of the conjunctival specimens displayed inflammatory infiltrates, which further validates the prior results regarding the proposed inflammatory mechanism of acquired punctal stenosis [20]. Outstandingly, all patients in their study were diagnosed with presumed idiopathic punctal stenosis.…”

Section: Discussionsupporting

confidence: 82%

Topical Cyclosporine-A for Management of Epiphora in Eyes with Acquired Punctal Stenosis

Nassief¹,

Abdelhameed²,

Hagras³

2022

OJOph

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Background: Cyclosporine A (CsA) is an inhibitor of calcineurin that prevents T-cell production of inflammatory cytokines and disrupts the immune-mediated inflammatory response that plays a crucial mechanism in punctal stenosis. Purpose: To evaluate the clinical outcomes and tolerances of CsA in treating epiphora in eyes with punctal stenosis. Study Design: Prospective study. Methods: The study included patients who presented with symptomatic epiphora associated with lower punctal stenosis during the period between July 2019 and December 2020. Patients were treated with topical 0.05% CsA on twice daily dose with topical preservative-free artificial tears Q.I. D. Patients were followed up monthly for at least 3 months by Munk epiphora grading, Fluorescein dye disappearance test (FDT) and evaluation of the patient satisfaction. Results: A total of 26 patients with 47 eyes were included in the study with a mean age of 55.1 ± 10.24 years. All the eyes had grade 0 lower punctal stenosis with grade 4 on Munk grading and grade 3 in FDT. There was a statistically significant difference in the Munk grading and FDT along the follow-up period compared to the baseline values (p < 0.001). Patient's satisfaction was complete in 7 (26.9%) patients in the first month and 19 (73%) by the 3 rd month. None of the patients encountered any complications during treatment. Conclusion: CsA can control the inflammation of the conjunctival sac and restore the integrity of the ocular surface with subsequent symptomatic relief of the epiphora in eyes with punctal stenosis.

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Section: Discussionsupporting

confidence: 82%

Topical Cyclosporine-A for Management of Epiphora in Eyes with Acquired Punctal Stenosis

Nassief¹,

Abdelhameed²,

Hagras³

2022

OJOph

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“…Research on idiopathic lacrimal punctal blockage is scant at best. All stenotic puncta were found to have subepithelial and subconjunctival fibrosis, according to histological and electro-microscopic examinations, but there was also significant inflammation and high immunoreactivity [9]. The current study aimed to explore medical therapy for treating idiopathic, non-infectious acquired puncta inflammation, which has not been extensively studied.…”

Section: Discussionmentioning

confidence: 99%

A Meta-analysis on the management options of Idiopathic Inflammatory Punctal Stenosis

Seif

Said

Diab

2023

Fayoum University Medical Journal

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Introduction: Punctal obstruction is the narrowing or complete blocking of the external opening of the lacrimal canaliculus. Acquired punctal obstruction with profuse epiphora is a rather common illness, with a prevalence ranging from 8.3% to 54.3%. Aim of the study:Aim of the study: To perform a meta-analysis on the management options for idiopathic inflammatory pyloric stenosis. Subjects and Methods:This meta-analysis follows the PRISMA flow diagram. We searched PubMed, Cochrane, Web of Science, Embase, and local databases for relevant clinical trials evaluating the management of idiopathic inflammatory punctal stenosis. The analysis was performed using the risk ratio (RR) for dichotomous data and the mean difference (MD) for continuous data, in addition to the 95% confidence interval (CI). The data were considered homogenous if the I2 was 50% and heterogenous if the I2 was > 50%.Results: Results showed significantly improved punctal staging in groups (I) and (III) compared to baseline, (P = 0.007 and 0.017, respectively). However, no significant improvement was observed in group II. The relative risk (RR) across all groups was 1.68 (95% CI: 1.03, 2.75, P = 0.04), indicating a significant improvement in the treatment at the assessment time. The analysis of individual stages showed that the treatment effect varied across stages, with a significant improvement observed in stage 3. The study also found a substantial increase in Outer Punctal Diameter (OPD) in the groups (I) and (III) immediately after the treatment compared to baseline, with a pooled effect size of -58.22 (95% CI: -108.50, -7.93, P = 0.02).Conclusions: Dexamethasone (0.1% non-preserved, 0.4% non-preserved) showed an effective, symptomrelieving, and outer punctal diameter (OPD) improvement as compared with the 0.1% preserved dexamethasone; on the other hand, the 0.4% non-preserved dexamethasone carried more risk of increasing the intra-ocular pressure (IOP).

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“…The punctum is the entry point for tears, and it is vulnerable to exogenous or endogenous irritants that could initiate the inflammatory process [ 5 , 16 ]. Inflammation, which is the physiological defence mechanism against various noxious stimuli, and subsequent fibrosis appear to be the currently proposed mechanism in the development of punctal stenosis [ 5 , 16 – 19 ]. Various histopathological studies have reported that inflammation and/or fibrosis were the main histopathological features, with rates ranging from 73 to 100% in punctal stenosis specimens [ 15 , 17 – 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Inflammation, which is the physiological defence mechanism against various noxious stimuli, and subsequent fibrosis appear to be the currently proposed mechanism in the development of punctal stenosis [ 5 , 16 – 19 ]. Various histopathological studies have reported that inflammation and/or fibrosis were the main histopathological features, with rates ranging from 73 to 100% in punctal stenosis specimens [ 15 , 17 – 19 ]. There is plentiful evidence that cellular stress conditions caused by oxidative stress and low-grade inflammation constitute the main mechanism involved in the pathogenesis of the fibrotic process in PXF [ 10 , 11 , 20 – 22 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of lacrimal drainage system in Pseudoexfoliation syndrome

Eroglu

Şekeroğlu

Ceran

et al. 2021

Eye

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Purpose To evaluate the prevalence of the obstruction of lacrimal drainage system (LDS) in patients with pseudoexfoliation (PXF) syndrome. Materials and Methods This cross-sectional study included 152 eyes of 76 consecutive patients with bilateral PXF syndrome and 170 eyes of 85 age and gender-matched controls. The LDS evaluation was performed based on dye disappearance test, slit-lamp examination, diagnostic probing, and irrigation test. The presence of punctal stenosis and canalicular obstruction were considered as the obstruction of proximal LDS; and complete or incomplete nasolacrimal duct obstruction was considered as obstruction of distal LDS. Demographic characteristics, ophthalmologic findings, and prevalence and site of obstruction of LDS were compared among the groups. Results The prevalence of obstruction of LDS was higher in the PXF syndrome group when compared to controls (21.1% vs 12.2%), but the difference was not statistically significant ( p = 0.061). The obstruction of proximal LDS was found to be more frequent in the PXF syndrome (17.7%) group when compared to controls (10.0%), and this difference was statistically significant ( p = 0.041). There was significantly more punctal stenosis in the PXF syndrome group when compared to controls (15.1% vs 7.6%, p = 0.033). The prevalence of canalicular stenosis and obstruction of distal LDS was similar in the PXF and the control groups ( p = 0.596 and p = 0.741, respectively). Conclusion The prevalence of punctal stenosis was statistically significantly higher in the PXF syndrome group when compared to the controls. This association is probably related to increased local ocular surface inflammation which is triggered by the accumulation of PXF material.

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Immunopathology and histopathology of conjunctival biopsies in patients with presumed idiopathic punctal stenosis

Cited by 13 publications

References 21 publications

Topical Cyclosporine-A for Management of Epiphora in Eyes with Acquired Punctal Stenosis

Topical Cyclosporine-A for Management of Epiphora in Eyes with Acquired Punctal Stenosis

A Meta-analysis on the management options of Idiopathic Inflammatory Punctal Stenosis

Evaluation of lacrimal drainage system in Pseudoexfoliation syndrome

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