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

Graefe's Archive for Clinical and Experimental Ophthalmology volume 258, pages 201–207 (2020)Cite this article

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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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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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

Keywords

  • Punch
  • Punctoplasty
  • Punctum
  • Stenosis