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Amit Reddy, Meredith Baker, Amanda Maltry, Nasreen A Syed, Richard C Allen; Immunopathology of conjunctival biopsies in patients with punctal stenosis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4731.
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Numerous etiologic processes and pharmacologic agents have been associated with punctal stenosis, yet until two recent papers examining punctal histopathology in patients with punctal stenosis, little was known about the underlying pathologic processes. These two papers reported that nearly all punctal specimens displayed signs of chronic inflammation. The purpose of this study is to expand upon these previous findings and examine the utility of conjunctival biopsy in patients with punctal stenosis without known risk factors.
A retrospective chart review was performed of patients who presented to the University of Iowa Hospital and Clinics between August 2009 and October 2014 with idiopathic epiphora, were clinically diagnosed with punctal stenosis, and underwent conjunctival biopsy for histopathologic and direct immunofluorescent (DIF) examination. Patients with known systemic or pharmacologic etiologies were excluded.
12 patients met inclusion criteria. Conjunctival biopsies from all 12 patients - 18 specimens - underwent histological examination. All 18 specimens showed a stromal lymphocytic infiltrate. Conjunctival biopsies from nine of the 12 patients - 12 specimens - were also evaluated by DIF. Three patients (33.3%) had depositions of shaggy and/or duplicative fibrinogen along the basement membrane zone.
Conjunctival specimens of all patients displayed stromal lymphocytic infiltrate, confirming the previously reported findings in punctoplasty specimens. While these previous studies were performed on punctal specimens, conjunctival tissue tends to be easier to access and provides greater amounts of tissue. That conjunctival biopsies displayed similar findings to those in the previous punctal specimens suggests that conjunctival biopsies may be useful in studying these patients.<br /> <br /> Three of nine patients showed abnormal fibrinogen morphologies that are consistent with lichen planus (LP). None of these patients had signs or symptoms of LP elsewhere in the body. These cases suggest that isolated LP may be a common and underdiagnosed cause of punctal stenosis in patients without other risk factors. Thus, patients meeting these criteria may benefit from prompt histopathologic and DIF examination.
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