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A histopathological study of lacrimal puncta in patients with primary punctal stenosis

  • Oculoplastics and Orbit
  • Published:
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Abstract

Purpose

We investigated the etiology of punctal stenosis based on the histopathological features of puncta and clinical correlations in punctal stenosis patients.

Methods

A retrospective review was conducted of 69 cases from 38 patients who were diagnosed with punctal stenosis. Slit-lamp examination, the lacrimal irrigation test, dacryocystography, and spectral domain-optical coherence tomography were performed for the evaluation of punctal occlusions. For treatment, punctoplasty using a punch biopsy with or without silicone tube insertion and histopathological examinations were performed.

Results

The pathological features of the punctal membranes were classified into two types of epithelia: squamous (95.7%, 66/69) and columnar (4.3%, 3/69). The squamous epithelial specimens were divided into three groups: fibrous tissue (66.8%, 48/69), goblet cells (21.8%, 48/69), and keratinization (4.3%, 3/69). Most of the subepithelial pathology was fibrosis (82.6%, 57/69), and inflammation was noted in 17.4% (12/69) of the patients. Subepithelial fibrosis was the most common pathological feature in patients exhibiting stenosis with a squamous epithelium, while inflammation was more strongly correlated with patients with a columnar epithelium. However, there was no correlation between the histopathological findings and treatment outcomes.

Conclusion

Our histopathological findings suggest that primary fibrosis of the stenotic punctum was caused by intrinsic inflammation of the puncta rather than spreading from the conjunctiva or eyelid. Punctoplasty was effective in treating punctal stenosis, regardless of the epithelial type.

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References

  1. Kakizaki H, Takahashi Y, Iwaki M, Nakano T, Asamoto K, Ikeda H, Goto E, Selva D, Leibovitch I (2011) Punctal and canalicular anatomy: implications for canalicular occlusion in severe dry eye. Am J Ophthalmol 153:229–237

    Article  Google Scholar 

  2. Ansari SA, Pak J, Shields M (2005) Pathology and imaging of the lacrimal drainage system. Neuroimaging Clin N Am 15:221–237

    Article  Google Scholar 

  3. Port AD, Chen YT, Lelli GJ Jr (2013) Histopathologic changes in punctal stenosis. Ophthalmic Plast Reconstr Surg 29:201–204

    Article  Google Scholar 

  4. Ali MJ, Mishra DK, Baig F, Lakshman M, Naik MN (2015) Punctal stenosis: histopathology, immunology, and electron microscopic features-a step toward unraveling the mysterious etiopathogenesis. Ophthalmic Plast Reconstr Surg 31:98–102

    Article  Google Scholar 

  5. Hur MC, Jin SW, Roh MS, Jeong WJ, Ryu WY, Kwon YH, Ahn HB (2017) Classification of lacrimal punctal stenosis and its related histopathological feature in patients with epiphora. Korean J Ophthalmol 31:375–382

    Article  Google Scholar 

  6. Keith CG (1968) Intubation of the lacrimal passages. Am J Ophthalmol 65:70–74

    Article  CAS  Google Scholar 

  7. Wong ES, Li EY, Yuen HK (2017) Long-term outcomes of punch punctoplasty with Kelly punch and review of literature. Eye (Lond) 31:560–565

    Article  CAS  Google Scholar 

  8. Hurwitz JJ (1996) Disease of the punctum. In: Hurwitz JJ (ed) The Lacrimal System. Lippincott-Raven, Philadelphia, pp 149–153

    Google Scholar 

  9. Sadiq SA, Downes RN (1998) Epiphora: a quick fix? Eye (Lond) 12:417–418

    Article  Google Scholar 

  10. Shahid H, Sandhu A, Keenan T, Pearson A (2008) Factors affecting outcome of punctoplasty surgery: a review of 205 cases. Br J Ophthalmol 92:1689–1692

    Article  CAS  Google Scholar 

  11. Chak M, Irvine F (2009) Rectangular 3-snip punctoplasty outcomes: preservation of the lacrimal pump in punctoplasty surgery. Ophthal Plast Reconstr Surg 25:134–135

    Article  Google Scholar 

  12. Sung Y, Park JS, Lew H (2017) Measurement of lacrimal punctum using spectralis domain anterior optical coherence tomography. Acta Ophthalmol 95:e619–e624

    Article  CAS  Google Scholar 

  13. Heindl LM, Jünemann AG, Kruse FE, Holbach LM (2010) Tumors of the lacrimal drainage system. Orbit 29:298–306

    Article  Google Scholar 

  14. Heindl LM, Junemann A, Holbach LM (2009) A clinicopathologic study of nasal mucosa in 350 patients with external dacryocystorhinostomy. Orbit 28:7–11

    Article  Google Scholar 

  15. Kashkouli MB, Beigi B, Murthy R, Astbury N (2003) Acquired external punctal stenosis: etiology and associated findings. Am J Ophthalmol 136:1079–1084

    Article  Google Scholar 

  16. Yuen SJ, Oley C, Sullivan TJ (2004) Lacrimal outflow dysgenesis. Ophthalmology 111:1782–1790

    Article  Google Scholar 

  17. Kornhauser T, Segal A, Walter E, Lifshitz T, Hartstein M, Tsumi E (2019) Idiopathic edematous punctal stenosis with chronic epiphora: preponderance in young women. Int Ophthalmol 39:1981–1986

    Article  Google Scholar 

  18. Kominami R, Yasutaka S, Taniguchi Y, Shinohara H (2000) Anatomy and histology of the lacrimal fluid drainage system. Okajimas Folia Anat Jpn 77:155–160

    Article  CAS  Google Scholar 

  19. Reddy AK, Baker MS, Maltry AC, Syed NA, Allen RC (2017) Immunopathology and histopathology of conjunctival biopsies in patients with presumed idiopathic punctal stenosis. Br J Ophthalmol 101:213–217

    Article  Google Scholar 

  20. Singh S, Rajput A, Mohamed A, Mittal V (2018) Spectral domain optical coherence tomography for measuring tear film meniscus height and its relationship with epiphora. Indian J Ophthalmol 66:1592–1594

    Article  Google Scholar 

  21. Do JR, Lee H, Baek S, Lee TS, Chang M (2016) Efficacy of postoperative mitomycin-C eye drops on the clinical outcome in endoscopic dacryocystorhinostomy. Graefes Arch Clin Exp Ophthalmol 254:785–790

    Article  CAS  Google Scholar 

  22. Liao SL, Kao SC, Tseng JH, Chen MS, Hou PK (2000) Results of intraoperative mitomycin C application in dacryocystorhinostomy. Br J Ophthalmol 84:903–906

    Article  CAS  Google Scholar 

  23. Cheng SM, Feng YF, Xu L, Li Y, Huang JH (2013) Efficacy of mitomycin C in endoscopic dacryocystorhinostomy: a systematic review and meta-analysis. PLoS One 8:e62737

    Article  CAS  Google Scholar 

  24. Rubinfeld RS, Pfister RR, Stein RM, Foster CS, Martin NF, Stoleru S, Talley AR, Speaker MG (1992) Serious complications of topical mitomycin-C after pterygium surgery. Ophthalmology 99:1647–1654

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, CHA Bundang Medical Center, College of Medicine, CHA University, #59 Yatap-ro, Bundang-gu, Seongnam, 13496, Republic of Korea

    Jeong Kyeong Jang, Sang Min Lee & Helen Lew

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  1. Jeong Kyeong Jang
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  2. Sang Min Lee
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  3. Helen Lew
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Correspondence to Helen Lew.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Jang, J.K., Lee, S.M. & Lew, H. A histopathological study of lacrimal puncta in patients with primary punctal stenosis. Graefes Arch Clin Exp Ophthalmol 258, 201–207 (2020). https://doi.org/10.1007/s00417-019-04514-9

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  • DOI: https://doi.org/10.1007/s00417-019-04514-9

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