Characterizing Congenital Double Punctum Anomalies: Clinical, Endoscopic, and Imaging Findings

Area of Science:

• Ophthalmology
• Anatomy

Background:

• Congenital double puncta are rare anatomical variations.
• Epiphora, or excessive tearing, can result from various nasolacrimal duct abnormalities.

Purpose of the Study:

• To characterize the anatomical anomaly of congenital double puncta.
• To identify factors contributing to epiphora in patients with double puncta.
• To evaluate treatment outcomes for epiphora associated with double puncta.

Main Methods:

• Retrospective review of patients with epiphora and double lacrimal puncta.
• Utilized optical coherence tomography (OCT), dacryocystography (DCG), and canalicular endoscopy for investigations.

Main Results:

• Five patients were identified with congenital double puncta and epiphora.
• OCT revealed morphological abnormalities in the medial punctum, with absent vertical components and superficial horizontal canaliculi in most cases.
• DCG and endoscopy showed varied lengths of accessory canaliculi and demonstrated coexisting nasolacrimal pathologies like stenosis and canaliculitis.

Conclusions:

• Congenital double puncta exhibit diverse underlying canalicular anomalies and heterogeneous clinical presentations.
• The medial punctum of the double puncta appears more morphologically abnormal.
• Effective treatment of associated nasolacrimal pathologies leads to significant improvement in epiphora.