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Punctal and canalicular anatomy: implications for canalicular occlusion in severe dry eye.
Am J Ophthalmol 2012; 153(2):229-237.e1AJ

Abstract

PURPOSE

To characterize the microscopic anatomy of the lacrimal punctum and canaliculi in relation to the tarsal plate, muscle of Riolan, and Horner muscle; and to report a novel technique to excise the horizontal canaliculus in severe dry eye patients.

DESIGN

Observational anatomic study and a retrospective case series.

METHODS

The microscopic anatomy was studied in 86 eyelids of 25 cadavers (age range: 45-96 years, mean: 79.5 years). Surgery was performed on 18 canaliculi of 7 patients with dry eyes (age range: 37-69 years, mean: 59.9 years). In the microscopic study, 32 eyelids were incised sagittally, 38 eyelids were incised horizontally (1 mm from the eyelid margin), and 16 eyelids were incised parallel to the tarsal plate. All specimens were stained with Masson trichrome. In the surgical group, probe-guided horizontal canalicular excision with incision of the Horner muscle to the lateral edge of the lacrimal caruncle was performed. Both canalicular stumps were cauterized.

RESULTS

In the microscopic anatomic study, the punctum and the vertical canaliculus were part of the tarsal plate with the muscle of Riolan, whereas the horizontal canaliculus was surrounded by the Horner muscle. In the surgical group, all the operated canaliculi were completely occluded without recanalization 12 months postoperatively. No complications were recorded.

CONCLUSIONS

Based on microscopic anatomic findings that the lacrimal punctum and the vertical canaliculus are part of the tarsal plate, and that the horizontal canaliculus is surrounded by the Horner muscle, excision of the horizontal canaliculus may be an effective technique to treat patients with severe dry eyes.

Authors+Show Affiliations

Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan. cosme@d1.dion.ne.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21982102

Citation

Kakizaki, Hirohiko, et al. "Punctal and Canalicular Anatomy: Implications for Canalicular Occlusion in Severe Dry Eye." American Journal of Ophthalmology, vol. 153, no. 2, 2012, pp. 229-237.e1.
Kakizaki H, Takahashi Y, Iwaki M, et al. Punctal and canalicular anatomy: implications for canalicular occlusion in severe dry eye. Am J Ophthalmol. 2012;153(2):229-237.e1.
Kakizaki, H., Takahashi, Y., Iwaki, M., Nakano, T., Asamoto, K., Ikeda, H., ... Leibovitch, I. (2012). Punctal and canalicular anatomy: implications for canalicular occlusion in severe dry eye. American Journal of Ophthalmology, 153(2), pp. 229-237.e1. doi:10.1016/j.ajo.2011.07.010.
Kakizaki H, et al. Punctal and Canalicular Anatomy: Implications for Canalicular Occlusion in Severe Dry Eye. Am J Ophthalmol. 2012;153(2):229-237.e1. PubMed PMID: 21982102.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Punctal and canalicular anatomy: implications for canalicular occlusion in severe dry eye. AU - Kakizaki,Hirohiko, AU - Takahashi,Yasuhiro, AU - Iwaki,Masayoshi, AU - Nakano,Takashi, AU - Asamoto,Ken, AU - Ikeda,Hiroshi, AU - Goto,Eiki, AU - Selva,Dinesh, AU - Leibovitch,Igal, Y1 - 2011/10/06/ PY - 2011/02/11/received PY - 2011/07/13/revised PY - 2011/07/13/accepted PY - 2011/10/11/entrez PY - 2011/10/11/pubmed PY - 2012/3/16/medline SP - 229 EP - 237.e1 JF - American journal of ophthalmology JO - Am. J. Ophthalmol. VL - 153 IS - 2 N2 - PURPOSE: To characterize the microscopic anatomy of the lacrimal punctum and canaliculi in relation to the tarsal plate, muscle of Riolan, and Horner muscle; and to report a novel technique to excise the horizontal canaliculus in severe dry eye patients. DESIGN: Observational anatomic study and a retrospective case series. METHODS: The microscopic anatomy was studied in 86 eyelids of 25 cadavers (age range: 45-96 years, mean: 79.5 years). Surgery was performed on 18 canaliculi of 7 patients with dry eyes (age range: 37-69 years, mean: 59.9 years). In the microscopic study, 32 eyelids were incised sagittally, 38 eyelids were incised horizontally (1 mm from the eyelid margin), and 16 eyelids were incised parallel to the tarsal plate. All specimens were stained with Masson trichrome. In the surgical group, probe-guided horizontal canalicular excision with incision of the Horner muscle to the lateral edge of the lacrimal caruncle was performed. Both canalicular stumps were cauterized. RESULTS: In the microscopic anatomic study, the punctum and the vertical canaliculus were part of the tarsal plate with the muscle of Riolan, whereas the horizontal canaliculus was surrounded by the Horner muscle. In the surgical group, all the operated canaliculi were completely occluded without recanalization 12 months postoperatively. No complications were recorded. CONCLUSIONS: Based on microscopic anatomic findings that the lacrimal punctum and the vertical canaliculus are part of the tarsal plate, and that the horizontal canaliculus is surrounded by the Horner muscle, excision of the horizontal canaliculus may be an effective technique to treat patients with severe dry eyes. SN - 1879-1891 UR - https://www.unboundmedicine.com/medline/citation/21982102/Punctal_and_canalicular_anatomy:_implications_for_canalicular_occlusion_in_severe_dry_eye_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9394(11)00587-3 DB - PRIME DP - Unbound Medicine ER -