Characterizing the Occluded Lacrimal Punctum Using Anterior Segment Optical Coherence Tomography

Area of Science:

• Ophthalmology
• Medical Imaging

Background:

• Epiphora, or excessive tearing, can result from absent or blocked lacrimal drainage puncta.
• Accurate characterization of these blockages is crucial for effective treatment.

Purpose of the Study:

• To evaluate the utility of enhanced depth anterior segment optical coherence tomography (OCT) for imaging absent or occluded lacrimal puncta and underlying canaliculi.
• To assess OCT's ability to visualize the lacrimal canaliculus beneath occluded puncta.

Main Methods:

• Prospective collection of anterior segment spectral domain OCT images from lower puncta of patients with epiphora and occluded puncta.
• OCT imaging was used to determine the visibility of the canaliculus below the occluded punctum.

Main Results:

• An epithelial-lined canalicular lumen was visualized by OCT in 4 out of 9 lower eyelid puncta from 2 patients.
• OCT identified 80% of canaliculi during microscope-assisted exploration, with lumens found within 580 micrometers of the eyelid margin.
• Successful punctoplasty for epiphora resolution was observed in half of the eyes where OCT identified a canaliculus.

Conclusions:

• Enhanced depth anterior segment OCT can successfully image lacrimal canaliculi when the punctum is occluded.
• This noninvasive OCT technique may help predict the likelihood of successful surgical retrieval of the canaliculus.