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Acquired Obliteration of the Proximal Lacrimal Drainage System.
Ophthalmic Plast Reconstr Surg. 2019 Jul/Aug; 35(4):342-345.OP

Abstract

PURPOSE

We present a series of patients with acquired obliteration of one or more components of the proximal lacrimal drainage system, including puncta and canaliculi. This finding was noted with and without other obstructions or stenoses of the lacrimal drainage system. Review of these patients in search of possible risk factors for this condition and histopathology of two patients are presented.

METHODS

Medical records of patients treated at the Massachusetts Eye and Ear Infirmary between 2010 and 2016 with diagnosis codes of lacrimal punctum stenosis, stenosis of unspecified lacrimal punctum, epiphora due to insufficient drainage, and epiphora not otherwise specified were retrospectively reviewed. Patients were excluded if there was a history of congenital punctal agenesis, trauma, or any other identifiable etiology of lacrimal system obstruction.

RESULTS

Twelve patients were identified with obliterated puncta. Most patients were female (n = 11, 91.7%) and Caucasian (n = 9, 75%). The mean age was 61 years (median 62, range 22-90 years). Clinical findings ranged from one involved punctum to all four puncta, and associated ipsilateral canalicular obstruction was noted in 4 patients (33.3%). The inferior puncta were the more frequently affected structures (61.5%) compared to the superior puncta (38.5%). Nine patients (75%) reported use of topical ophthalmic medications prior to onset of symptoms. The most frequent class of medication implicated was topical antibiotics; however, patients often used a combination of medications. In 2 cases, pathological specimens of the canaliculi revealed absence of a canalicular lumen.

CONCLUSIONS

Although various combinations of lacrimal system stenoses and obstructions have been described, acquired punctal obliteration is an under-recognized entity. These cases differ from typical punctal stenosis in that the puncta are completely obliterated, and no indication of a punctal opening is clinically detectable. In this study, 3 patients had previously documented normal lacrimal irrigation. The ipsilateral canaliculi were also found to be obstructed in a third of patients. Two patients had complete absence of a canalicular lumen on histopathology. The predominance of inferior punctum involvement, patient history of symptom onset after ipsilateral medication use, and known prior patent irrigation in several cases support the hypothesis that these cases represent a severe yet insidious idiosyncratic reaction to topical medication.

Authors+Show Affiliations

Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, Massachusetts, U.S.A.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30365474

Citation

Starks, Victoria S., and Michael K. Yoon. "Acquired Obliteration of the Proximal Lacrimal Drainage System." Ophthalmic Plastic and Reconstructive Surgery, vol. 35, no. 4, 2019, pp. 342-345.
Starks VS, Yoon MK. Acquired Obliteration of the Proximal Lacrimal Drainage System. Ophthalmic Plast Reconstr Surg. 2019;35(4):342-345.
Starks, V. S., & Yoon, M. K. (2019). Acquired Obliteration of the Proximal Lacrimal Drainage System. Ophthalmic Plastic and Reconstructive Surgery, 35(4), 342-345. https://doi.org/10.1097/IOP.0000000000001244
Starks VS, Yoon MK. Acquired Obliteration of the Proximal Lacrimal Drainage System. Ophthalmic Plast Reconstr Surg. 2019 Jul/Aug;35(4):342-345. PubMed PMID: 30365474.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acquired Obliteration of the Proximal Lacrimal Drainage System. AU - Starks,Victoria S, AU - Yoon,Michael K, PY - 2018/10/27/pubmed PY - 2020/1/1/medline PY - 2018/10/27/entrez SP - 342 EP - 345 JF - Ophthalmic plastic and reconstructive surgery JO - Ophthalmic Plast Reconstr Surg VL - 35 IS - 4 N2 - PURPOSE: We present a series of patients with acquired obliteration of one or more components of the proximal lacrimal drainage system, including puncta and canaliculi. This finding was noted with and without other obstructions or stenoses of the lacrimal drainage system. Review of these patients in search of possible risk factors for this condition and histopathology of two patients are presented. METHODS: Medical records of patients treated at the Massachusetts Eye and Ear Infirmary between 2010 and 2016 with diagnosis codes of lacrimal punctum stenosis, stenosis of unspecified lacrimal punctum, epiphora due to insufficient drainage, and epiphora not otherwise specified were retrospectively reviewed. Patients were excluded if there was a history of congenital punctal agenesis, trauma, or any other identifiable etiology of lacrimal system obstruction. RESULTS: Twelve patients were identified with obliterated puncta. Most patients were female (n = 11, 91.7%) and Caucasian (n = 9, 75%). The mean age was 61 years (median 62, range 22-90 years). Clinical findings ranged from one involved punctum to all four puncta, and associated ipsilateral canalicular obstruction was noted in 4 patients (33.3%). The inferior puncta were the more frequently affected structures (61.5%) compared to the superior puncta (38.5%). Nine patients (75%) reported use of topical ophthalmic medications prior to onset of symptoms. The most frequent class of medication implicated was topical antibiotics; however, patients often used a combination of medications. In 2 cases, pathological specimens of the canaliculi revealed absence of a canalicular lumen. CONCLUSIONS: Although various combinations of lacrimal system stenoses and obstructions have been described, acquired punctal obliteration is an under-recognized entity. These cases differ from typical punctal stenosis in that the puncta are completely obliterated, and no indication of a punctal opening is clinically detectable. In this study, 3 patients had previously documented normal lacrimal irrigation. The ipsilateral canaliculi were also found to be obstructed in a third of patients. Two patients had complete absence of a canalicular lumen on histopathology. The predominance of inferior punctum involvement, patient history of symptom onset after ipsilateral medication use, and known prior patent irrigation in several cases support the hypothesis that these cases represent a severe yet insidious idiosyncratic reaction to topical medication. SN - 1537-2677 UR - https://www.unboundmedicine.com/medline/citation/30365474/Acquired_Obliteration_of_the_Proximal_Lacrimal_Drainage_System_ L2 - http://dx.doi.org/10.1097/IOP.0000000000001244 DB - PRIME DP - Unbound Medicine ER -