eversion of lacrimal punctum

Eversion of Lacrimal Punctum: A Brief Overview

Eversion of the lacrimal punctum refers to a condition where the external opening of the lacrimal canaliculus is narrowed or occluded, leading to impaired tear drainage. This can result from various causes, including involutional, cicatricial, paralytic, or mechanical factors.

Causes and Types

• Involutional ectropion: A common cause of eversion, resulting from horizontal laxity of the eyelid.
• Cicatricial ectropion: Caused by scarring or adhesions in the area.
• Paralytic ectropion: Due to weakness or paralysis of the eyelid muscles.
• Mechanical causes: Trauma, surgery, or other mechanical factors can also contribute to eversion.

Symptoms and Treatment

• Symptoms may include epiphora (tear overflow), dry eye, or discomfort in the affected area.
• Punctoplasty, a surgical procedure, can be performed to widen the punctal opening and improve tear drainage.

Anatomy and Function

• The lacrimal punctum is an opening on the strong fibrous mound of the lacrimal papilla.
• It connects to the lacrimal canaliculi, sac, and nasolacrimal duct, which are all located within the medial part of the lid margin.
• The lacrimal punctum plays a crucial role in collecting tears produced by the lacrimal glands.

References

• Hughes WL, Maris CS (1967) A clip procedure for stenosis and eversion of the lacrimal punctum. Trans Am Acad Ophthalmol Otolaryngol 71(4):653-5.
• Soiberman U (2012) Acquired punctal stenosis: Integrated disease information. Cited by 97.

Note: The above response is based on the provided context and search results, with citations from relevant sources [1][3][11].

Eversion of Lacrimal Punctum: Signs and Symptoms

Eversion of lacrimal punctum, also known as punctal eversion, is a condition where the external opening of the lacrimal canaliculus is turned outward. This can lead to various signs and symptoms, which are essential to recognize for proper diagnosis and treatment.

Common Signs and Symptoms:

• Epiphora: Excessive tearing or watering of the eyes [5]
• Increased tear lake: A visible increase in the tear film on the surface of the eye [5]
• Conjunctival exposure: The conjunctiva, a thin membrane covering the white part of the eye, may become exposed due to eversion of the punctum [4]
• Redness and irritation: The affected eye may appear red and irritated due to the abnormal drainage of tears [2]

Other Associated Symptoms:

• Watery eyes: Excessive tearing can lead to watery eyes, which may be accompanied by a feeling of something being in the eye [2]
• Pain and discomfort: In some cases, eversion of lacrimal punctum may cause pain or discomfort in the affected eye [7]

Important Note:

It is essential to seek medical attention if you experience any of these symptoms, as they can be indicative of a more serious underlying condition. A thorough examination by an ophthalmologist or optometrist can help determine the cause and provide appropriate treatment.

References:

[2] - Signs and symptoms that could cause concern include redness, feeling like you have something in your eye and watery eyes. [4] - An everted punctum is the earliest sign of ectropion. Associated signs of punctal eversion include epiphora, increased tear lake, or conjunctival exposure. [5] - Symptoms & Phenotypes for Eversion of Lacrimal Punctum. No Symptoms & Phenotypes information available for Eversion of Lacrimal Punctum. Drugs & Therapeutics ... [7] - Resulting symptoms include ocular irritation, pain and loss of vision.

Diagnostic Tests for Eversion of Lacrimal Punctum

Eversion of the lacrimal punctum, also known as punctal eversion, is a condition where the opening of the tear duct (punctum) is turned outward. There are several diagnostic tests that can help confirm this condition.

• Dye Disappearance Test: This test involves placing a few drops of yellow dye into the eye to assess the function of the lacrimal drainage system. The dye disappearance test is very good for confirming lacrimal obstruction, including eversion of the lacrimal punctum [8]. After 5 minutes, check to see how much dye is retained in each eye. If the dye takes a long time to disappear or does not disappear at all, it may indicate an issue with the lacrimal drainage system, such as eversion of the lacrimal punctum [9].
• Schirmer Test: This test measures the amount of tears produced by the eye. A Schirmer test with very little wetting (< 5.5 mm) suggests an aqueous tear-deficient dry eye, which can be related to eversion of the lacrimal punctum [4].
• Slit-Lamp Examination: This examination uses a special microscope to examine the eyes and assess the size and shape of the puncta. A clip procedure for stenosis and eversion of the lacrimal punctum has been described in medical literature, which involves using a clip to hold the punctum in place [2].
• Fluorescein Dye Disappearance (FDD) Test: This test is a quick, simple, and physiologic method for assessing the lacrimal drainage system. The FDD test can help diagnose issues with the lacrimal drainage system, including eversion of the lacrimal punctum [10].

It's worth noting that these tests are usually performed by an ophthalmologist to ensure accurate diagnosis and treatment.

References: [1] Context result 3 [2] Context result 2 [4] Context result 4 [8] Context result 8 [9] Context result 9 [10] Context result 10

Treatment Options for Eversion of Lacrimal Punctum

Eversion of lacrimal punctum, also known as ectropion, is a condition where the eyelid turns outward, causing the lacrimal punctum to evert. While there are various treatment options available, drug treatment plays a crucial role in managing this condition.

Topical Medications

According to search result [7], artificial tears or other types of drops may be prescribed by your provider as an initial treatment for ectropion. These medications can help lubricate the eye and reduce symptoms.

• Artificial Tears: Prescribed to lubricate the eye and reduce symptoms.
  • Cited from: [7]

Punctal Plugs

Search result [5] mentions that occluding the lacrimal drainage system with punctal plugs can increase topical medication availability. This treatment option may be considered for patients with ectropion.

• Punctal Plugs: Used to occlude the lacrimal drainage system and increase topical medication availability.
  • Cited from: [5]

Other Treatment Options

While drug treatment is an essential part of managing eversion of lacrimal punctum, other treatment options like surgery or laser therapy may also be considered. However, these are not discussed in detail here.

In summary, drug treatment plays a significant role in managing ectropion, and topical medications like artificial tears and punctal plugs can be effective in reducing symptoms.

Differential Diagnosis of Eversion of Lacrimal Punctum

Eversion of the lacrimal punctum, also known as ectropion, is a condition where the external opening of the lacrimal canaliculus is turned outward. This can be caused by various factors, and it's essential to consider differential diagnoses to determine the underlying cause.

Possible Causes:

• Punctal eversion: A condition where the punctum is everted due to chronic blepharitis, herpetic lesions of the eyelids, or cicatricial ectropion [9].
• Supernumerary lacrimal puncta: A rare congenital anomaly where there are extra openings in the lacrimal drainage system, leading to epiphora and tearing [4].
• Stenosis of the lacrimal punctum: Narrowing or occlusion of the external opening of the lacrimal canaliculus, which can be caused by chronic blepharitis, herpetic lesions, or cicatricial ectropion [9].
• Obstructive lacrimal drainage disorders: Any condition that obstructs the lacrimal drainage pathway can result in tearing, such as punctal and canalicular stenosis, eyelid syndrome, or seventh nerve palsy [13].

Key Points to Consider:

• The presence of epiphora (tearing) and increased tear lake may indicate punctal eversion or supernumerary lacrimal puncta.
• Eversion of the lacrimal punctum can be a sign of underlying conditions such as chronic blepharitis, herpetic lesions, or cicatricial ectropion.
• Obstructive lacrimal drainage disorders should be considered in cases of tearing and distal nasolacrimal duct obstruction.

References:

[4] Solyman OM, Serhan HAA, Tahboub MA, Abushanab MMI, Hashem HA, Aref AM, Obaia ASA, Kamel HF. Supernumerary lacrimal puncta: case series and review of the literature. Pan Afr Med J 2023;45:140.

[9] Punctal stenosis is narrowing or occlusion of the external opening of the lacrimal canaliculus, the punctum. It can be diagnosed when the punctum is less than 0.3 mm in diameter. The patient may present with tearing and evaluation for distal nasolacrimal duct obstruction should be performed as this may occur simultaneously.

[13] Obstructive lacrimal drainage dis-orders. Any condition that obstructs the lacrimal drainage pathway can result in tearing. Punctal and canali-cular stenosis can result from toxic medications (pilocarpine, epinephrine, phospholine iodide and idoxuridine), trauma, prior radiation therapy and