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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 1  |  Page : 30-31

Anterior segment optical coherence tomography characteristics of pseudopunctum in proximal canalicular blocks


Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India

Date of Submission20-May-2020
Date of Acceptance14-Jul-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Ruchi Goel
Department of Ophthalmology, Guru Nanak Eye Centre, Maharaja Ranjeet Singh Marg, Near Zakir Hussain College, 64 Khamba, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1594_20

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  Abstract 


Keywords: Canalicular block, OCT, pseudopunctum


How to cite this article:
Goel R, Golhait P, Khanam S, Raghav S, Kumar S. Anterior segment optical coherence tomography characteristics of pseudopunctum in proximal canalicular blocks. Indian J Ophthalmol Case Rep 2021;1:30-1

How to cite this URL:
Goel R, Golhait P, Khanam S, Raghav S, Kumar S. Anterior segment optical coherence tomography characteristics of pseudopunctum in proximal canalicular blocks. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Feb 27];1:30-1. Available from: https://www.ijoreports.in/text.asp?2021/1/1/30/305494



Anterior segment optical coherence tomography (AS-OCT) is a non-invasive method, employed for structural assessment of lacrimal punctum.[1] Being considered as in vivo clinical biopsy, its use has been explored for diagnosis and post intervention monitoring of punctal procedures.[2]

DCR with retrograde intubation and pseudopunctum creation is used for the management of proximal canalicular blocks.[3] We describe the characteristics of pseudopunctum in 10 eyes with bicanalicular blocks, <6 mm from the true punctum that were managed with DCR with bicanalicular silicone intubation tube with pseudopunctum creation. The tubes were removed after 6 weeks and at 6th month, after confirming anatomical patency on syringing, AS-OCT was done. The pseudopunctum was studied in terms of external lacrimal punctum diameter (ELP), internal lacrimal punctum diameter (ILP) and vertical canalicular height (VCH) and compared with those reported in literature.[4]

The pseudopunctum was 'funnel-shaped' [Figure 1], [Figure 2], [Figure 3] with sloping walls as compared to 'cylindrical' shape and nearly vertical walls of true punctum [Figure 4]. Distinct layers of canalicular wall were discernible and tear film was visualized as a meniscus at the mouth of pseudopunctum as in true punctum.
Figure 1: (a) Clinical photograph of right lower pseudopunctum (white arrow) and true punctum (yellow arrow) (b) AS-OCT of pseudopunctum showing funnel-shaped opening with a steep medial wall and a gradually curved lateral wall with long vertical canaliculus; distinct tissue layers seen as varying degrees of hyperreflectivity (red lines i, ii, iii) (c) infrared image indicating axis of scan

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Figure 2: (a) Clinical photograph of left lower pseudopunctum (white arrow) and true punctum (yellow arrow) (b) AS-OCT of pseudopunctum showing wide outer diameter with gradual curving of lateral wall compared to the taller medial wall; tear meniscus visible as a hyperreflective line at the mouth (c) infrared image of pseudopunctum showing axis of scan

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Figure 3: (a) Clinical photograph of left lower pseudopunctum (white arrow) and true punctum (yellow arrow) (b) AS-OCT shows wide-mouthed pseudopunctum with gradual sloping of both the walls; ILP can be seen opening in medial wall, tear meniscus is visible as a hyperreflective line with underlying hyperreflective mottled areas (c) infrared image indicating axis of scan

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Figure 4: (a) Clinical photograph of the true right lower punctum (white arrow) (b) AS-OCT showing a gradual symmetrical sloping of both medial and lateral walls with distinct layers of tissue histologically identified as (i) epithelium (ii) dense fibrous tissue (iii) muscle of Riolan; tear meniscus is seen as a hyperreflective area in the lumen (c) infrared image indicating axis of scan

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The mean ELP of pseudopunctum was 809.7 ± 166.217 μ that was significantly wider than that reported for the true punctum, 424.65 ± 170.546 μ (independent t test P value = 0.0001). The mean ILP of pseudopunctum was found to be 197.6 ± 36.676 μ, which was comparable to that of true punctum, 234.34 ± 144.375 μ (independent t test P value = 0.4456). The mean VCH of pseudopunctum 550 ± 153.815 μ was found to be significantly greater than that of true punctum 250.44 ± 109.880 μ (independent t test P value = 0.0001).


  Discussion Top


The overall size of pseudopunctum was observed to be significantly larger, providing a roomy entry for tears into the lacrimal drainage system. AS-OCT hence offers a no-touch objective technique for postoperative assessment of pseudopunctum.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wawrzynski JR, Smith J, Sharma A, Saleh GM. Optical coherence tomography imaging of the proximal lacrimal system. Orbit 2014;33:428-32.  Back to cited text no. 1
    
2.
Drexler W, Fujimoto JG. State-of-the-art retinal optical coherence tomography. Prog Retin Eye Res 2008;27:45-88.  Back to cited text no. 2
    
3.
Wearne MJ, Beigi B, Davis G, Rose GE. Retrograde intubation dacryocystorhinostomy for proximal and midcanalicular obstruction. Ophthalmology 1999;106:2325-8.  Back to cited text no. 3
    
4.
Allam RSHM, Ahmad RA. Evaluation of the lower punctum parameters and morphology using spectral domain anterior segment optical coherence tomography. J Ophthalmol 2015:591845.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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