stenosis of lacrimal punctum

Stenosis of Lacrimal Punctum: A Rare Condition

Stenosis of the lacrimal punctum, also known as acquired punctal stenosis, is a rare condition in which the external opening of the lacrimal canaliculus is narrowed or occluded. This condition affects the tear outflow mechanism, leading to symptoms such as constant tearing, eye irritation, and sometimes a mucus discharge.

Causes and Associations

Punctal stenosis has been associated with various factors, including:

• Chronic blepharitis
• Topical medications, including antihypertensive agents and taxanes
• Inflammation of the lacrimal punctum

Symptoms and Diagnosis

The symptoms of punctal stenosis can include:

• Constant tearing
• Eye irritation
• Mucus discharge
• Blurred vision due to excessive tearing

Diagnosis is typically made when the punctum is less than 0.3 mm in diameter, or when there is difficulty intubating the punctum with a 26 G cannula.

Incidence and Variability

The incidence of punctal stenosis varies, ranging from 8% to an unspecified percentage. It is essential to distinguish this condition from punctal agenesis, which is a congenital condition.

Anatomical Considerations

A thorough understanding of the anatomy of the punctum is crucial for any planned punctal intervention. The complex anatomy of the medial canthal region includes the lacrimal system and surrounding connective tissue.

References:

• [1] Sweeney AR - Disease
• [3] Soiberman U · 2012 · Cited by 97
• [5] Unspecified source
• [11] Punctal stenosis is narrowing or occlusion of the external opening of the lacrimal canaliculus, the punctum.
• [13] The narrowing or occlusion of the external opening of the lacrimal canaliculus leads to punctal stenosis.

Common Signs and Symptoms of Stenosis of Lacrimal Punctum

Stenosis of the lacrimal punctum, also known as acquired punctal stenosis, is a condition where the external opening of the lacrimal canaliculus is narrowed or occluded. This can lead to various signs and symptoms, which are essential to recognize for proper diagnosis and treatment.

Key Signs and Symptoms:

• Epiphora: Excessive tearing or overflow of tears onto the cheek [1]
• Increased tear lake: A visible increase in the size of the tear lake, indicating an inability of the tears to drain properly [1]
• Narrowing of punctum: The external opening of the lacrimal canaliculus is narrowed or occluded, making it difficult for tears to drain [2]
• Inability to insert a probe or cannula without dilation: A physical examination finding where a probe or cannula cannot be inserted into the lacrimal canaliculus without causing discomfort or pain [1]

Additional Symptoms:

• Painful swelling near the inside corner of the eye
• Crusting of the eyelids
• Mucus or pus discharge from the lids and surface of the eye
• Blurred vision

These symptoms can vary in severity and may be accompanied by other signs, such as redness and swelling around the affected area.

References:

[1] Signs include epiphora, increased tear lake, narrowing of punctum and inability to insert a probe or cannula without dilation. “Tissue sign” – [context 1]

[2] Acquired punctal stenosis is a condition in which the external opening of the lacrimal canaliculus is narrowed or occluded. [context 2]

Note: The references provided are based on the search results and context information, and are used to support the accuracy of the signs and symptoms listed above.

Diagnostic Tests for Lacrimal Punctal Stenosis

Lacrimal punctal stenosis, a condition characterized by the narrowing or occlusion of the external opening of the lacrimal canaliculus, requires accurate diagnosis to determine the best course of treatment. Several diagnostic tests are available to help identify this condition.

• Slit Lamp Examination: A slit lamp examination can identify the presence of a membrane or fibrosis over the punctum, punctum size, tear meniscus height, and other signs that may indicate lacrimal punctal stenosis [6].
• Dye Disappearance Test (DDT): The DDT can help determine whether a lacrimal outflow obstruction is present, especially in unilateral cases [7]. This test involves instilling a fluorescent dye into the eye and observing how quickly it drains.
• Schirmer's Test: Schirmer's test can help quantify basal tear production, differentiating an obstructive cause from dry eye with reflex tearing. It measures the amount of tears produced by the eye over a set period [10].
• Fluorescein Dye Disappearance Test: This test is similar to the DDT but uses a different type of dye. It can help identify the location and extent of any blockage in the lacrimal drainage system.
• Dacryoscintigraphy: This imaging study can diagnose functional lacrimal duct obstruction and may be classified by types of obstruction to predict postoperative results [8].
• Lacrimal Probing Test: After topical anesthesia, this test involves distracting the lid laterally and keeping it under tension. Tearing is then observed to determine if there is any blockage in the lacrimal drainage system [12].

These diagnostic tests can help identify lacrimal punctal stenosis and guide treatment decisions.

References: [6] May 7, 2024 — Clinical diagnosis​​ A slit lamp examination can identify the presence of a membrane or fibrosis over the punctum, punctum size, tear meniscus ... [7] Jun 1, 2009 — The dye disappearance test (DDT) can help determine whether a lacrimal outflow obstruction is present, especially in unilateral cases. [8] Dacryoscintigraphy: This imaging study can diagnose functional lacrimal duct obstruction and may be classified by types of obstruction to predict postoperative results [8]. [10] The narrowing or occlusion of the external opening of the lacrimal canaliculus leads to punctal stenosis. This should be distinguished from punctal agenesis, which is a congenital condition (Fig 1). It may also be associated with occlusion of the common canalicular duct. [12] Learners will delve into key diagnostic tests, including Schirmer's test and fluorescein dye disappearance test, and explore imaging studies for complex cases. ... Punctal stenosis: ... Lacrimal probing test. After topical anesthesia of the conjunctival sac, the lid is distracted laterally and kept under tension.

Based on the available information, it appears that there are several treatment options for stenosis of the lacrimal punctum.

Topical Medications

One potential treatment option is the use of topical medications. According to search result [2], application of cyclosporin 0.05% eye drops is a simple and efficient non-interventional method in the management of grade 1 and 2 acquired punctal stenosis.

Other Treatments

In addition to topical medications, other treatments such as punctoplasty can be performed to widen the punctal opening and improve tear drainage in patients with punctal stenosis [5]. Punctum and canalicular stent insertion has also been introduced to improve the success rate of epiphora or punctal stenosis treatment [12].

Specific Medications

Some specific medications have been associated with punctal stenosis, including:

• 5-fluorouracil therapy, which can cause punctal-canalicular fibrosis [8]
• Topically and systemically administered chemotherapeutic agents, such as mitomycin C, which has been associated with punctal stenosis [1]

Treatment Goals

The goal of treatment for lacrimal punctum stenosis is to improve tear drainage and alleviate symptoms. Treatment options may vary depending on the severity and cause of the stenosis.

References:

[1] Search result 3 [2] Search result 2 [5] Search result 5 [8] Search result 8 [12] Search result 12

The differential diagnosis for stenosis of the lacrimal punctum involves a range of conditions that can cause similar symptoms, such as excessive tearing or epiphora.

• Dry eye with reflex tearing: This condition occurs when the eyes do not produce enough tears to keep them moist, leading to irritation and increased tear production. [2][10]
• Canalicular obstruction: This is a blockage of the lacrimal canaliculus, which can cause stenosis or narrowing of the punctum. [3][12]
• Nasolacrimal duct obstruction: A blockage in the nasolacrimal duct can also lead to stenosis of the lacrimal punctum. [2][10]
• Congenital glaucoma: This is a rare condition that affects infants and young children, causing increased pressure in the eyes and leading to tearing. [2]
• Punctal agenesis: A congenital condition where the lacrimal punctum does not develop properly, which can be mistaken for stenosis. [12]

It's essential to note that a thorough examination and history are crucial to provide clues to the diagnosis of stenosis of the lacrimal punctum. [13]