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The management of punctal agenesis.
Ophthalmology. 1993 Dec; 100(12):1851-5.O

Abstract

BACKGROUND

Agenesis of one or more lacrimal puncta is a rare cause of presentation to ophthalmologists. Where normal canalicular tissue lies within the lid, it may occasionally be successfully exteriorized to the conjunctival surface with relief of symptoms. The pattern of punctal agenesis, its relationship to the presence of underlying canalicular tissue, and its management have not been defined previously in a large cohort.

METHODS

The authors reviewed the pattern of agenesis, underlying anatomic abnormalities and patient symptomatology in 57 patients seen over a 10-year period. A management plan was devised for eyes with no puncta and those with a single missing punctum.

RESULTS

Both puncta were absent in 53 eyes, and a single punctum was missing in 41 eyes. In 86% of eyes with absence of both puncta, no canalicular tissue was identified when the lacrimal sac was opened at surgery. The underlying canaliculus also was absent in patients with one absent punctum. Nasolacrimal duct obstruction frequently accounted for the onset of symptoms in patients with a single punctum. Fifty-three (93%) of the 57 operated eyes were functionally cured at the completion of this report.

CONCLUSION

Punctal agenesis usually is associated with the absence of underlying canalicular tissue. Where both puncta are absent, the authors recommend inspection of the internal opening of the common canaliculus at surgery and, if no canalicular tissue can be identified (86% in this series), insertion of a Lester-Jones tube. Symptomatic patients with a single punctum frequently require surgery to relieve nasolacrimal rather than canalicular obstruction.

Authors+Show Affiliations

Moorfields Eye Hospital, London, United Kingdom.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8259286

Citation

Lyons, C J., et al. "The Management of Punctal Agenesis." Ophthalmology, vol. 100, no. 12, 1993, pp. 1851-5.
Lyons CJ, Rosser PM, Welham RA. The management of punctal agenesis. Ophthalmology. 1993;100(12):1851-5.
Lyons, C. J., Rosser, P. M., & Welham, R. A. (1993). The management of punctal agenesis. Ophthalmology, 100(12), 1851-5.
Lyons CJ, Rosser PM, Welham RA. The Management of Punctal Agenesis. Ophthalmology. 1993;100(12):1851-5. PubMed PMID: 8259286.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The management of punctal agenesis. AU - Lyons,C J, AU - Rosser,P M, AU - Welham,R A, PY - 1993/12/1/pubmed PY - 1993/12/1/medline PY - 1993/12/1/entrez SP - 1851 EP - 5 JF - Ophthalmology JO - Ophthalmology VL - 100 IS - 12 N2 - BACKGROUND: Agenesis of one or more lacrimal puncta is a rare cause of presentation to ophthalmologists. Where normal canalicular tissue lies within the lid, it may occasionally be successfully exteriorized to the conjunctival surface with relief of symptoms. The pattern of punctal agenesis, its relationship to the presence of underlying canalicular tissue, and its management have not been defined previously in a large cohort. METHODS: The authors reviewed the pattern of agenesis, underlying anatomic abnormalities and patient symptomatology in 57 patients seen over a 10-year period. A management plan was devised for eyes with no puncta and those with a single missing punctum. RESULTS: Both puncta were absent in 53 eyes, and a single punctum was missing in 41 eyes. In 86% of eyes with absence of both puncta, no canalicular tissue was identified when the lacrimal sac was opened at surgery. The underlying canaliculus also was absent in patients with one absent punctum. Nasolacrimal duct obstruction frequently accounted for the onset of symptoms in patients with a single punctum. Fifty-three (93%) of the 57 operated eyes were functionally cured at the completion of this report. CONCLUSION: Punctal agenesis usually is associated with the absence of underlying canalicular tissue. Where both puncta are absent, the authors recommend inspection of the internal opening of the common canaliculus at surgery and, if no canalicular tissue can be identified (86% in this series), insertion of a Lester-Jones tube. Symptomatic patients with a single punctum frequently require surgery to relieve nasolacrimal rather than canalicular obstruction. SN - 0161-6420 UR - https://www.unboundmedicine.com/medline/citation/8259286/The_management_of_punctal_agenesis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(93)31386-2 DB - PRIME DP - Unbound Medicine ER -