Histopathologic changes in punctal stenosis

Abstract

 

Purpose

 

To describe the pathologic changes in punctal stenosis by reporting the histopathologic findings in a series of punctoplasty specimens.

 

Methods

 

Observational retrospective chart review. Electronic health records of all patients having punctoplasty over a two-year period at an academic oculoplastic practice were examined. All patients whose records included pathology reports were entered into a database.

 

Results

 

24 patients, representing 30 eyes, had pathology records in the EHR. Patients were 75% female, and had an average age of 65 (19-88). Associated conditions included blepharitis (71%), dry eye syndrome or Meibomian gland dysfunction (63%).Histopathologic examination demonstrated chronic inflammation in 11 eyes (36.7%), fibrosis in 7 eyes (23.3%), chronic inflammation and fibrosis in 4 eyes (13.3%), squamous metaplasia in 3 eyes (10%), normal conjunctival mucosa in 3 eyes (10%), and Acintomyces Israelii canaliculitis in 2 eyes (6.7%).

 

Conclusions

 

Nearly all histopathologic specimens revealed findings consistent with inflammation, fibrosis, or both. These findings provide evidence to support the hypothesis that the many etiologic causes of punctal stenosis are linked by a common pathophysiologic mechanism involving inflammation.

 

 

Representative histopathology findings in 3-snip punctoplasty specimens. (A) Chronic inflammation with mainly lymphocytic infiltrates in the conjunctival epithelium and underlying tissue. Magnification 400X

 

 

Representative histopathology findings in 3-snip punctoplasty specimens. (B) Densely fibrotic collagenous scar tissue with no or minimal residual inflammation.Magnification 200X

 

Keywords: 638 pathology: human