[Optical coherence tomography in the diagnosis of pathologies of the horizontal portion of the lacrimal drainage system]. / Opticheskaya kogerentnaya tomografiya v diagnostike patologii gorizontal'nogo otdela slezootvodyashchikh putei.

This article reviews literature on the use of optical coherence tomography in studying the anatomical structure of the proximal lacrimal drainage system, as well as in diagnosing its pathological changes. Determining the reference values of the parameters of the lacrimal punctum and the lacrimal canaliculus remains an important issue. The review describes the advantages and disadvantages of this method, as well as the prospects for its application in clinical practice.

[Punctal stenosis: etiology, diagnosis, treatment]. / Stenoz sleznoi tochki: etiologiya, diagnostika, lechenie.

This article reviews etiological factors in the development of lacrimal punctal stenosis, modern diagnostic techniques, as well as both conservative and surgical treatment methods. The presented analysis is based on data from 67 literary sources, which provide information on conventional and high-tech examination and treatment methods of patients with lacrimal punctal stenosis. Particular attention is paid to various aspects of punctoplasty - the most common surgical intervention used to treat this pathology.

Imaging and anatomical parameters of the lacrimal punctum and vertical canaliculus using optical coherence tomography.

Purpose: The anatomical parameters of normal lacrimal puncta and vertical canaliculus using optical coherence tomography (OCT) and the OCT imaging features of punctal lesions were analyzed to provide a basis for clinical diagnosis and treatment. Methods: From June to September 2019, 40 volunteers (80 eyes) from Tongji Hospital were enrolled. The external punctal diameter (ELP) was measured using slit-lamp microscopy and OCT. The internal lacrimal punctal diameter (ILP) at 100 µm, vertical canalicular length (VCL), and tear meniscus depth were measured by OCT with open eyes. Twenty-eight volunteers (56 eyes) underwent the same examinations with their eyes closed. The OCT imaging features of 26 patients (27 eyes) with lacrimal lesions were examined. Results: The ELP of the right and left healthy eyes under slit-lamp microscopy were 564.40 and 555.40 µm respectively. Under OCT, the ELP, ILP, and VCL of the right and left eyes were 628.20 um and 616.85 µm, 343.40 µm and 346.95 µm, 731.95 um and 709.20 µm respectively. The ELP was larger when measured by OCT than slit-lamp microscopy (p<0.05). Twenty-eight volunteers (56 eyes) had measurements taken under different conditions. The ELP, ILP, and VCL of the open and closed right eyes were 667.54 and 567.21 µm, 369.18 and 303.18 µm, 715.00 and 417.14 µm, respectively. The ELP, ILP, and VCL of the open and closed left eyes were 655.86 um and 551.68 µm, 369.25 um and 313.54 µm, 719.96 um and 433.89 µm respectively. The anatomical parameters of the open eyes were greater than those of the closed eyes (p<0.05). Thus, we identified the imaging features of lacrimal stenosis, punctal obstruction, punctal tear, lacrimal atresia, and lacrimal mass using OCT. Conclusions: OCT can be used to measure the anatomical parameters of lacrimal puncta and vertical canaliculus in vivo. In addition, OCT can detect punctal lesions in vivo and provide an objective basis for the clinical diagnosis and treatment of punctal lesions.

Imaging of proximal lacrimal system with time domain anterior segment optical coherence tomography in Asian Indian population.

This article reports proximal lacrimal system parameters using Anterior Segment Optical Coherence Tomography (ASOCT-Visante) in an apparently normal Asian Indian population with assessment of any correlation between tear meniscus height and punctal diameter. This was a prospectively designed observational study that included healthy adults, who volunteered for optical coherence tomography imaging (OCT) of their proximal lacrimal system. Time domain ASOCT (Visante) images of the punctum and proximal canaliculus were captured using the high resolution corneal scan protocol. External lacrimal punctal diameter (ELP), internal lacrimal punctal diameter (ILP), vertical canalicular length (VCL) and tear meniscus height (TMH) were calculated. Statistical analysis was performed using Pearson's correlation test. Our study had 100 normal subjects with mean age 24.14 years, range 15-38 years. ASOCT (Visante) with advantage of deeper penetration was able to image canaliculus in all cases. The mean TMH, ELP, ILP and VCL was 252.7 ± 67.98 µm, 382.2 ± 103.14µm, 140.7 ± 67.29 µm and 811.8 ± 253.7 µm, respectively, in 100 normal subjects. No correlation was found between ELP, ILP and TMH (Pearson's Correlation; r = -0.355, p > 0.05 for all). ASOCT (VisanteTM) is a non-invasive and easy to use objective tool for imaging proximal lacrimal system. Further studies are required to validate normative data and correlate with microscopic findings of lacrimal system.

Epiphora due to a supernumerary lacrimal punctum treated with lacrimal plugs. Case presentation and literature review.

ANTECEDENTES: Los puntos lagrimales supernumerarios son una malformación congénita poco común y con una variabilidad anatómica importante. En muchas ocasiones pueden ser sintomáticos y cursar con epífora. CASO CLÍNICO: Se describe el caso de un paciente de 45 años con epífora secundaria a un punto lagrimal supernumerario sin otra patología lagrimal asociada tratado exitosamente con el uso de tapones de vías lagrimales. CONCLUSIONES: Los tapones de vías lagrimales para el tratamiento de la epífora secundaria a puntos lagrimales supernumerarios pueden ser utilizados en pacientes con variantes anatómicas adecuadas. BACKGROUND: Supernumerary lacrimal punctum is a rare malformation of the lacrimal apparatus with a highly variable anatomical presentation. In many cases this can be symptomatic and cause tearing. CASE PRESENTATION: The case of a 45 year old male with a supernumerary lacrimal punctum and tearing without any other associated lacrimal system anomaly treated successfully with lacrimal plugs. CONCLUSIONS: Lacrimal plugs can be used as an alternative treatment in selected cases of symptomatic supernumerary lacrimal punctum with epiphora.

Diagnosis of lacrimal punctum lesions using optical coherence tomography: a preliminary study.

AIM: To study the imaging characteristics of lacrimal punctum lesion with optical coherence tomography (OCT), and provide imaging basis for the diagnosis and treatment of lacrimal punctum diseases. METHODS: A total of 25 patients (28 eyes) with epiphora and lacrimal puncta lesions were enrolled. Lacrimal puncta lesions included: punctum membrane obstruction in 7 cases (9 eyes), punctum agenesis in 1 case (1 eye), a mass protruded from the punctum in 1 case (1 eye), slit puncta in 1 case (1 eye), peri-puncta mass in 2 cases (2 eyes), chronic dacryocystitis in 4 cases (4 eyes), and primary puncta stenosis in 9 cases (10 eyes; 3 eyes mild, 4 eyes moderate and 3 eyes severe). All patients were examined by slit lamp microscopy and OCT to observe the morphological characteristics of abnormal punctum. RESULTS: Two types of complete membrane obstruction and incomplete membrane obstruction of puncta were observed in OCT images of 7 patients. No lacrimal punctum and lacrimal canalicular cavity were found in 1 case with punctum agenesis. OCT images showed that a narrow lumen remained in the lacrimal puncta in 1 patient with a mass protruded from the punctum. OCT of punctum in a patient with slit punctum after stent placement showed stent and abnormal lacrimal structure. No abnormal intraluminal structure was found in 2 cases of peri-puncta mass after OCT scan, and the lacunar space was narrower than that of the contralateral eye. OCT of puncta in 4 patients with chronic dacryocystitis showed that pus floated in tear with lump-like medium-low reflex. In 9 patients with primary lacrimal puncta stenosis, OCT image could clearly show the changes of puncta lumen in different degrees and shapes. CONCLUSION: OCT is feasible for the examination of pathological punctum, and can provide imaging basis for the diagnosis and treatment of punctum disease.

Punctal agenesis: Embryology, presentation, management modalities and outcomes.

Punctal agenesis is defined as the absence of the punctum occurring secondary to a failure of embryogenesis. This review synthesizes existing data on the embryology, anatomy, clinical presentation, symptomatology, management options and treatment outcomes of punctal agenesis. A foundational knowledge of the underlying embryologic and anatomical abnormalities is fundamental to understanding its clinical presentation and assists in choosing an appropriate management strategy. Existing outcomes data is generally favorable and suggests management with a step-wise approach can alleviate symptoms in patients across a spectrum of disease.

Primary lacrimal canaliculitis - A clinical entity often misdiagnosed.

PURPOSE: Primary lacrimal canaliculitis (PLC) is a unique disorder which often gets misdiagnosed by the general as well as speciality-trained ophthalmologists. Elderly patients with history of chronic or recurrent epiphora with discharge, often get mislead towards chronic dacryocystitis. The aim of our report is to discuss the misleading diseases in our PLC patients and to revisit this hidden disease. METHODS: The patients of PLC who were previously misdiagnosed were studied. The clinical history, presenting clinical features, misdiagnosis, and final management of the patients is described. RESULTS: There were 5 misdiagnosed female patients. A history of chronic redness, watering, discharge, and medial canthal region edema lead to the misdiagnosis of chronic dacryocystitis in 3 (60%) and medial marginal chalazion in 2 (40%) cases. Slit-lamp examination revealed localized hyperemia (n = 5), classical pouting of lacrimal punctum (n = 3), and expressible purulent discharge (n = 3). Two patients without punctum pouting had an explicit yellowish hue/discoloration of the canalicular region. Our patients had a mean 4 visits before an accurate diagnosis. Three-snip punctoplasty with canalicular curettage was performed in three while two were managed conservatively. At last follow-up, all patients were symptom-free with punctum and canalicular scarring in three, who underwent surgery. CONCLUSION: PLC is a frequently misdiagnosed clinical entity which delays the initiation of appropriate treatment. A succinct magnified examination of punctum and canalicular region can provide sufficient clues pivotal for accurate diagnosis.

Measurement of lacrimal punctum using spectralis domain anterior optical coherence tomography.

PURPOSE: Anterior segment optical coherence tomography (AS-OCT) was used to image the lacrimal punctum and establish normal punctal parameters including the tear volume inside the punctum. METHODS: This study included totally 67 eyes from 38 normal subjects. Punctal parameters and tear meniscus height (TMH) were measured using spectralis OCT anterior-segment scans. Outer punctal diameter (OPD), punctal depth, tear well diameter (TWD), tear well depth, punctal reserve (PR) and lower eyelid TMH were assessed. Authors defined a 'tear well' as a pool of standing tears in the punctum. Punctal reserve was defined as the difference between punctal depth and tear well depth. RESULTS: Outer punctal diameter was 614.6 ± 195.6 µm, the punctal depth was 545.8 ± 270.1 µm, TWD was 229.9 ± 133.8 µm, the tear well depth was 434.9 ± 247.8 µm, the PR was 110.9 ± 72.9 µm, the PR ratio was 0.20 ± 0.17, and the TMH was 222.9 ± 88.8 µm. The punctal depth decreased significantly according to the patient's age (correlation coefficient = -0.352, respectively). CONCLUSION: AS-OCT is useful for improving anatomical understanding of the lacrimal punctal structure. Quantitative punctum and tear well measurements were correlated with TMH.

Characterizing the lacrimal punctal region using anterior segment optical coherence tomography.

PURPOSE: Abnormalities of lacrimal punctum size and morphology probably contribute to excess tearing, with significant effects on quality-of-life for affected individuals. Our current understanding of normal punctal morphology originates from ex vivo studies, which are unlikely to capture the true nature of the living punctum. This study used enhanced depth anterior segment optical coherence tomography (OCT) to give improved characterization and understanding of lacrimal punctal structure. METHODS: Qualitative and quantitative assessments were performed on spectral domain OCT images collected prospectively from 40 lower puncta of 20 healthy volunteers. RESULTS: The average external lower lid punctal diameter was 0.646 mm (SD 150 µm) on OCT imaging, measured at the largest diameter, which was in parallel to the mucocutaneous junction. Fifty-five per cent of puncta appeared closed, whilst the eyelids were open. Fluid menisci were visible within 73% of puncta. A postpunctal 'ampulla' was visible within three systems, one of which was imaged through the conjunctival surface. Ampullary dilatation occurred laterally, rather than at the medial wall. CONCLUSION: Optical coherence tomography provides quick and non-invasive assessment of the lacrimal punctum and its neighbouring tissue layers. This assessment of punctal size and morphology has the potential for further investigation of punctal physiology, for aiding diagnosis, and for monitoring the results of treatment. The average external diameter of the punctal opening measured in this study is greater than that recorded in anatomical textbooks.

Puntoplastia en dos cortes modificada en estenosis de puntos y canalículos lagrimales inferiores / Modified two-snip punctoplasty for stenosis of inferior lacrimal points and canaliculi

RESUMEN Objetivo: Determinar los resultados alcanzados con la utilización de la puntoplastia en dos cortes modificada en el manejo de los pacientes con estenosis de los puntos y canalículos lagrimales inferiores. Métodos: Se realizó un estudio descriptivo y retrospectivo de una serie de casos, en el Hospital Universitario Clínico Quirúrgico "Comandante Manuel Fajardo", desde enero del año 2016 a diciembre de 2018. La muestra quedó conformada por 22 pacientes (38 ojos), sometidos a la técnica quirúrgica, y fue caracterizada de acuerdo con la edad, el sexo, el color de la piel, la bilateralidad, la localización anatómica de la obstrucción, los antecedentes patológicos personales, las complicaciones y la evaluación funcional final. Resultados: De un total de 22 pacientes, 17 estuvieron entre las edades de 60 y 79 años, el 72,7 por ciento del sexo femenino y el 86,4 por ciento con piel de color blanco. La blefaritis fue el principal antecedente oftalmológico encontrado (18,2 por ciento), la obstrucción fue bilateral en el 72,7 por ciento de los casos, y fundamentalmente a nivel del punto lagrimal (16 casos). El 86,8 por ciento no mostró complicaciones posoperatorias; 3 casos presentaron extrusión del tutor de silicona, los cuales estuvieron en relación con el fallo en el resultado final. En el 92,1 por ciento se constató el éxito de la cirugía. Conclusiones: La estenosis de la vía lagrimal se produce principalmente en mujeres, de raza blanca, mayores de 60 años y sin antecedentes patológicos referidos. La afectación es más frecuente a nivel del punto lagrimal. Con la técnica quirúrgica se logra un resultado excelente y con complicaciones mínimas(AU)

ABSTRACT Objective: Determine the results achieved by modified two-snip punctoplasty in the management of patients with stenosis of inferior lacrimal points and canaliculi. Methods: A retrospective descriptive study was conducted of a case series at Comandante Manuel Fajardo Clinical Surgical University Hospital from January 2016 to December 2018. The sample was 22 patients (38 eyes) undergoing the surgical technique. The variables studied were age, sex, skin color, bilaterality, anatomical location of the obstruction, personal pathological antecedents, complications and final functional evaluation. Results: Of the total 22 patients, 17 were in the 60-79 years age group, 72.7 percent were female and 86.4 percent were white. Blepharitis was the main ophthalmological antecedent (18.2 percent). Obstruction was bilateral in 72.7 percent of the cases, fundamentally at the lacrimal punctum (16 cases). 86.8 percent did not have any postoperative complication, whereas 3 presented extrusion of the silicone tutor. These were related to failure in the final result. Surgery was successful in 92.1 percent of the cases. Conclusions: Lacrimal duct stenosis prevails in white skin women aged over 60 years without reported pathological antecedents. The disorder is more common at the lacrimal punctum. The surgical technique used achieves excellent results with minimum complications(AU)

Management of nasolacrimal duct injuries in mid-facial advancement.

Nasolacrimal duct (NLD) may be injured following trauma. During certain surgical procedure, inadvertent damage to the nasolacrimal apparatus may occur as well. Such instances should be immediately managed to prevent any subsequent complications. The management of such inadvertent injuries may be accomplished only with a thorough anatomic comprehension and surgical expertise in the field of operation. It also requires the presence of armamentarium required for its management in situations when complications arise. The case report discusses one such rare complication of NLD injury during Le Fort III osteotomy and advancement effectively managed by bicanalicular stenting.

A Lacrimal Punctal Keratinizing Cyst of the Lower Lid

PURPOSE: We report an unusual case of a keratinizing cyst on the lacrimal punctum. CASE SUMMARY: A 49-year-old female presented with an outpouching punctal mass at the left lower lid that occurred a week prior to her visit. Histopathological examination revealed a cyst filled with keratin arranged in lamina and surrounding the bacterial colony. The epithelial wall was composed of multilaminar, keratinizing squamous epithelium without goblet cells. The features were consistent with a keratinizing cyst. There was no recurrence at 4 months after the excision, and the punctum was patent. CONCLUSIONS: Keratinizing cyst should be considered as a differential diagnosis of the cystic mass of the punctum. Because it has an excellent prognosis after surgical resection, complete resection should be performed if a keratinizing cyst is suspected.

An Unusual Case of Double Lacrimal Puncta

PURPOSE: Congenital double puncta are usually unilateral, and the accessory punctum exists on the medial side in a slit configuration that is distinct from the shape of the normal punctum. We report a case of an unusual case of double lacrimal puncta which the lateral, rather than the medial, punctum was judged to be the accessory punctum. CASE SUMMARY: A 39-year-old male patient with no underlying disease and no ophthalmologic history visited our clinic with right eye epiphora of 2 weeks duration. On slit lamp examination, double puncta were observed in the right lower eyelid and the remaining puncta were normal. On lacrimal syringing test and dacryocystography were performed and revealed incomplete obstruction with partial narrowing of the nasolacrimal duct. Silicone tube intubation was performed through the right lower medial punctum and symptoms improved postoperatively. CONCLUSIONS: The present case is an unusual case of double lacrimal puncta which has not been reported in Korea. Unlike the previous literature, the lateral, rather than the medial, punctum was judged to be the accessory punctum. Because accessory punctm can be present on the lateral side, it is necessary to distinguish between the accessory punctm and the main punctum through the accurate dacryocystography and lacrimal syringing test for the treatment of the patient.

Successful micro-resection of lacrimal punctum neoplasm using XL -radiofrequency ablation skin apparatus under a microscope / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To study the therapeutic method of XL -radiofrequency ablation skin apparatus (invented by Rehabilitation medicine, PLA General Hospital) in micro-resecting the lacrimal punctum neoplasm and to observe its clinical effects. ·METHODS:XL-radiofrequency ablation skin apparatus was performed on 7 cases (7 eye lesions) of lacrimal punctum neoplasm including 3 intradermal nevus, 1 boundary nevus, 1 mixed nevus with inflammatory granuloma,1 inflammatory granuloma,and 1 squamous papillary cell tumor by separating layer, point and flake removing methods. The clinical effect was investigated 2-6mo postoperatively and leftover was removed by twice. The postoperative follow- up durations ranged from 6 to 60mo. ·RESULTS: Totally 6 cases (6 eye lesions) were cured successfully by once but 1 case by twice. They were all without recurrence, cicatrix, palpebral margin deformity, obstruction of lacrimal punctum, stenosis of lacrimal punctum or epiphora. Micro - resecting the lacrimal punctum neoplasm using the XL-radiofrequency ablation skin apparatus had several advantages, such as high accuracy,no cicatrix,no bleeding,no epiphora,no damage to the structure of lacrimal canaliculus, short operation time, little pain during the procedure, without hospitalization, slight inflammation reaction after procedure. ·CONCLUSION: The efficacy of XL - radiofrequency ablation skin apparatus is significantly more evident and highly accurate in micro - resecting lacrimal punctum neoplasm.

To study the result of the therapeutic effect of Sea buckthorn oil using grab taper lacrimal punctum / Шинэ санаа Шинэ нээлт

Studied with comparing the results of the method of zone which using the Hippophae rhamnoides and normal zone to 22 people who got narrow of lacrimal punctum. In the result of treatment the people’s lacrimal punctum was widen for 64.2% and 64.2% repeated who are zoned normal and the people’s lacrimal punctum was widen for 75% and 12.5% repeated who are zoned with oil of Hippophae rhamnoides after 14-21 days. Here after future, we need to use research the method of using the oil of hippophae hamnoidesfor eyes practice.

Study of lacrimal Punctal Size in Normal Adults

To investigate of lacrimal punctal size in normal korean adults, we measured diameter and area of punctum and punctal papilla according to sex and age group using slit lamp photography in 120 persons, 120 eyes. In upper eyelid, the average diameter and area of lacrimal punctum were 0.57+/-0.2mmxo.29+/-0.1mm, 0.13+/-0.07mm2 andthe average diameter and area of punctal papilla were 1.34+/-0.37mmx0.89+/-0.24mm, 0.98+/-0.53mm2. In lower eyelid, the average diameter and area of lacrimal punctum were 0.61+/-0.17mmx0.3+/-0.1mm, 0.15+/-0.08mm2 and the average diameter and area of punctal papilla were 1.46+/-0.32mmx0.99+/-0.19mm, 1.15+/-0.4mm2. In size difference between lacrimal punctum, lower punctum was larger than upper punctum, but not statistically significant. In size difference between punctal papilla, lower papilla was significantly larger than upper papilla. There is no difference in punctal and papilla size between male and female. The size distribution of punctum was related to age, but size distribution of papilla was not.