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Characterizing the lacrimal punctal region using anterior segment optical coherence tomography.
Acta Ophthalmol 2016; 94(2):154-9AO

Abstract

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.

Authors+Show Affiliations

Lacrimal Clinic, Moorfields Eye Hospital, London, UK.NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.Lacrimal Clinic, Moorfields Eye Hospital, London, UK.Lacrimal Clinic, Moorfields Eye Hospital, London, UK.Lacrimal Clinic, Moorfields Eye Hospital, London, UK. NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.Lacrimal Clinic, Moorfields Eye Hospital, London, UK. NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26648481

Citation

Timlin, Hannah M., et al. "Characterizing the Lacrimal Punctal Region Using Anterior Segment Optical Coherence Tomography." Acta Ophthalmologica, vol. 94, no. 2, 2016, pp. 154-9.
Timlin HM, Keane PA, Day AC, et al. Characterizing the lacrimal punctal region using anterior segment optical coherence tomography. Acta Ophthalmol. 2016;94(2):154-9.
Timlin, H. M., Keane, P. A., Day, A. C., Salam, T., Abdullah, M., Rose, G. E., & Ezra, D. G. (2016). Characterizing the lacrimal punctal region using anterior segment optical coherence tomography. Acta Ophthalmologica, 94(2), pp. 154-9. doi:10.1111/aos.12906.
Timlin HM, et al. Characterizing the Lacrimal Punctal Region Using Anterior Segment Optical Coherence Tomography. Acta Ophthalmol. 2016;94(2):154-9. PubMed PMID: 26648481.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characterizing the lacrimal punctal region using anterior segment optical coherence tomography. AU - Timlin,Hannah M, AU - Keane,Pearse A, AU - Day,Alexander C, AU - Salam,Tahrina, AU - Abdullah,Mohammed, AU - Rose,Geoffrey E, AU - Ezra,Daniel G, Y1 - 2015/12/09/ PY - 2015/04/30/received PY - 2015/09/23/accepted PY - 2015/12/10/entrez PY - 2015/12/10/pubmed PY - 2016/9/30/medline KW - ampulla KW - epiphora KW - lacrimal punctum KW - non-invasive KW - optical coherence tomography SP - 154 EP - 9 JF - Acta ophthalmologica JO - Acta Ophthalmol VL - 94 IS - 2 N2 - 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. SN - 1755-3768 UR - https://www.unboundmedicine.com/medline/citation/26648481/Characterizing_the_lacrimal_punctal_region_using_anterior_segment_optical_coherence_tomography_ L2 - https://doi.org/10.1111/aos.12906 DB - PRIME DP - Unbound Medicine ER -