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Nam Yeong Kim, Mun Chong Hur, Yoon Hyung Kwon, Won Yeol Ryu, Hee-Bae Ahn; Classification and clinical characteristics of epiphora with punctal stenosis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4454.
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To evaluate the classification of punctal stenosis according to the shape of external punctum and related symptom and clinical characteristics adding to investigated histopathologic finding of stenotic punctum.
Patients who has tearing and diagnosed as punctal stenosis between May 2013 and January 2014 were evaluated. Punctal stenosis was diagnosed with slit lamp exam and classified according to lower external punctum shape, membranous obstruction type, operculum type, slit type, fibrotic circular type. Control group without epiphora and punctal stenosis also evaluated. Clinical characteristics like tear meniscus height, 2% fluorescine dye disappearance test(2% FDDT) and lacrimal pathway irrigation were also done and statistical correlation with dermographic data also analyzed. As treatment, Punctal snip operation and silicone tube intubation was done and histopathologic finding of punctum was evaluated.
The mean age of punctum stenosis group(43 patients, 79 eyes) was 65.69 ± 7.84 years. and control group(30 Patients, 60 eyes) was 60.3 ± 6.31 years. Punctal stenosis was classified to four types and it was divided to fibrotic circular type 26 eyes(34.17%), operculum type 25 eyes(32.65%), membranous obstruction type 17 eyes(20.25%), slit type 11eyes(13.92%) and this distribution was not statistically significant(p=0.054). And there was no statistically significant correlation of clinical exam and types of punctal stenosis, but tear meniscus was higher and 2% fluorescine dye was disappeared slower at the type of membranous obstruction than other types. The histopathologic finding of punctum showed loss of connective tissue at the margin of conjunctiva, punctum and horizontal canaliculus. and muscle of riolan was prominantly found within 0.1mm from canalicular endothelium.
The fibrotic circular stenosis was represented as the most common type of punctal stenosis in four different shapes classification. Although these classification is not significant related to tearing symptom, but, membranous obstruction group showed elevated tear meniscus height and the histopathologic findings were compatible to the shape.
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