Diagnosis of lacrimal punctum lesions using optical coherence tomography: a preliminary study

AIM:To study the imaging characteristics of lacrimal punctum lesion with optical coherence tomography(OCT),and provide imaging basis for the diagnosis and treatment of lacrimal punctum diseases.METHODS:A total of 25 patients(28 eyes)with epiphora and lacrimal puncta lesions were enrolled.Lacrimal puncta lesions included:punctum membrane obstruction in 7 cases(9 eyes),punctum agenesis in 1 case(1 eye),a mass protruded from the punctum in 1 case(1 eye),slit puncta in 1 case(1 eye),peri-puncta mass in 2 cases(2 eyes),chronic dacryocystitis in 4 cases(4 eyes),and primary puncta stenosis in 9 cases(10 eyes;3 eyes mild,4 eyes moderate and 3 eyes severe).All patients were examined by slit lamp microscopy and OCT to observe the morphological characteristics of abnormal punctum.RESULTS:Two types of complete membrane obstruction and incomplete membrane obstruction of puncta were observed in OCT images of 7 patients.No lacrimal punctum and lacrimal canalicular cavity were found in 1 case with punctum agenesis.OCT images showed that a narrow lumen remained in the lacrimal puncta in 1 patient with a mass protruded from the punctum.OCT of punctum in a patient with slit punctum after stent placement showed stent and abnormal lacrimal structure.No abnormal intraluminal structure was found in 2 cases of peri-puncta mass after OCT scan,and the lacunar space was narrower than that of the contralateral eye.OCT of puncta in 4 patients with chronic dacryocystitis showed that pus floated in tear with lump-like medium-low reflex.In 9 patients with primary lacrimal puncta stenosis,OCT image could clearly show the changes of puncta lumen in different degrees and shapes.CONCLUSION:OCT is feasible for the examination of pathological punctum,and can provide imaging basis for the diagnosis and treatment of punctum disease.