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Characterizing Congenital Double Punctum Anomalies: Clinical, Endoscopic, and Imaging Findings.

Abstract

PURPOSE

To characterize the anatomical anomaly of congenital double puncta, identify factors contributing to epiphora and its treatment.

METHODS

Retrospective review of patients presenting with epiphora and a double lacrimal punctum over a 6-month period.

RESULTS

Five consecutive patients (3 female) were identified. The median age was 50 years (range 34-76). Investigations included punctum optical coherence tomography, dacryocystography, and canalicular endoscopy. The medial punctum was more morphologically abnormal when compared with healthy puncta, with optical coherence tomography showing no vertical canalicular component in 80% (4/5) of patients, and a more superficial than usual horizontal canaliculus in 80% (4/5). Dacryocystography and canalicular endoscopy showed the junction of the 2 inferior canaliculi, which was very proximal in 1, mid canalicular in 2, and at the level of the common canaliculus in 2. In 1 patient, the only abnormality identified was the double lower punctum, with a high tear meniscus and delayed fluorescence dye disappearance test. They underwent endonasal dacryocystorhinostomy with improvement of epiphora. In the other 4 patients, causes of epiphora were nasolacrimal duct stenosis with mucocoele, punctal stenosis, common canalicular stenosis with nasolacrimal duct stenosis, upper canaliculitis, and blepharitis. Their treatments included endonasal dacryocystorhinostomy, punctoplasty, canaliculotomy, and blepharitis treatment. All had improvement of epiphora following treatment.

CONCLUSIONS

These findings suggest that the underlying canalicular anomalies are varied and that the clinical manifestation is also heterogenous. Optical coherence tomography imaging suggests that the medial of the 2 puncta is the more morphologically abnormal one, with dacryocystography and canalicular endoscopy demonstrating different accessory canaliculi lengths.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30865065

Citation

Timlin, Hannah M., et al. "Characterizing Congenital Double Punctum Anomalies: Clinical, Endoscopic, and Imaging Findings." Ophthalmic Plastic and Reconstructive Surgery, 2019.
Timlin HM, Keane PA, Ezra DG. Characterizing Congenital Double Punctum Anomalies: Clinical, Endoscopic, and Imaging Findings. Ophthalmic Plast Reconstr Surg. 2019.
Timlin, H. M., Keane, P. A., & Ezra, D. G. (2019). Characterizing Congenital Double Punctum Anomalies: Clinical, Endoscopic, and Imaging Findings. Ophthalmic Plastic and Reconstructive Surgery, doi:10.1097/IOP.0000000000001368.
Timlin HM, Keane PA, Ezra DG. Characterizing Congenital Double Punctum Anomalies: Clinical, Endoscopic, and Imaging Findings. Ophthalmic Plast Reconstr Surg. 2019 Mar 8; PubMed PMID: 30865065.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characterizing Congenital Double Punctum Anomalies: Clinical, Endoscopic, and Imaging Findings. AU - Timlin,Hannah M, AU - Keane,Pearse A, AU - Ezra,Daniel G, Y1 - 2019/03/08/ PY - 2019/3/14/entrez PY - 2019/3/14/pubmed PY - 2019/3/14/medline JF - Ophthalmic plastic and reconstructive surgery JO - Ophthalmic Plast Reconstr Surg N2 - PURPOSE: To characterize the anatomical anomaly of congenital double puncta, identify factors contributing to epiphora and its treatment. METHODS: Retrospective review of patients presenting with epiphora and a double lacrimal punctum over a 6-month period. RESULTS: Five consecutive patients (3 female) were identified. The median age was 50 years (range 34-76). Investigations included punctum optical coherence tomography, dacryocystography, and canalicular endoscopy. The medial punctum was more morphologically abnormal when compared with healthy puncta, with optical coherence tomography showing no vertical canalicular component in 80% (4/5) of patients, and a more superficial than usual horizontal canaliculus in 80% (4/5). Dacryocystography and canalicular endoscopy showed the junction of the 2 inferior canaliculi, which was very proximal in 1, mid canalicular in 2, and at the level of the common canaliculus in 2. In 1 patient, the only abnormality identified was the double lower punctum, with a high tear meniscus and delayed fluorescence dye disappearance test. They underwent endonasal dacryocystorhinostomy with improvement of epiphora. In the other 4 patients, causes of epiphora were nasolacrimal duct stenosis with mucocoele, punctal stenosis, common canalicular stenosis with nasolacrimal duct stenosis, upper canaliculitis, and blepharitis. Their treatments included endonasal dacryocystorhinostomy, punctoplasty, canaliculotomy, and blepharitis treatment. All had improvement of epiphora following treatment. CONCLUSIONS: These findings suggest that the underlying canalicular anomalies are varied and that the clinical manifestation is also heterogenous. Optical coherence tomography imaging suggests that the medial of the 2 puncta is the more morphologically abnormal one, with dacryocystography and canalicular endoscopy demonstrating different accessory canaliculi lengths. SN - 1537-2677 UR - https://www.unboundmedicine.com/medline/citation/30865065/Characterizing_Congenital_Double_Punctum_Anomalies:_Clinical,_Endoscopic,_and_Imaging_Findings L2 - http://dx.doi.org/10.1097/IOP.0000000000001368 DB - PRIME DP - Unbound Medicine ER -