Medical treatment of inflammatory punctual stenosis monitored by anterior segment optical coherence tomography

AIM:To evaluate the role of medical treatment in the management of inflammatory punctum stenosis guided by spectral domain anterior segment optical coherence tomography(OCT).METHODS:This prospective study included 60 patients complaining of epiphora due to inflammatory punctual stenosis.They were divided into two groups:Group A(30 patients)treated with a combination of preservative free hydrocortisone sodium phosphate 3.35 mg/m L eye drops,and preservative free artificial tears based on sodium hyaluronate,polyethylene and propylene Glycol;Group B(30 patients)treated with the same preservative free artificial tears only.Thirty normal subjects were included for comparison of pre-treatment anatomical parameters.Before starting treatment,all patients underwent anterior segment assessment including slit lamp examination,measurement of intraocular pressure(IOP),fluorescein dye disappearance test,and measurement of the outer punctum diameter(OPD)by Spectral domain anterior segment OCT.All assessments were repeated at each follow up done at 1 and 3 mo later,together with subjective evaluation of patient’s satisfaction of the treatment outcome by simple rating questionnaire.RESULTS:Punctual diameter increased significantly with treatment in both groups(P<0.0001);although the widening was more in Group A as compared to group B(16.2%vs 8%of the original punctual size,mean difference of 28.933μm,P=0.0076).Subjective satisfaction with treatment outcome was also better in group A(70%vs 40%,Chi-square P=0.0397).CONCLUSION:A combination of preservative free steroid eye drops and artificial tears causes significant widening of inflammed stenotic punctae and improvement of the associated epiphora.

Punctal Stenosis a Rare Complication of Dupilumab Therapy for Atopic Dermatitis: A New Case Report

Background: Dupilumab is the biological drug approved for the treatment of moderate to severe atopic dermatitis (AD) and has demonstrated impressive clinical effect and quality of life-enhancing capacity in clinical trials. The most commonly observed adverse effects of dupilumab therapy included upper respiratory tract infection, headache, nasopharyngitis, injection-site reaction, herpes viral infection, and conjunctivitis. Lacrimal duct obstruction or punctal stenosis is rarely reported side effect of dupilumab therapy and not fully documented. Aim: To document a new case presentation of a young female with a history of AD without previous significant ocular manifestations who developed right eye punctal stenosis while she was on Dupilumab therapy for a one-year duration. Case Report: A 19-year-old female with a long-standing history of AD and on dupilumab therapy for one year duration who developed severe punctal stenosis and continued tearing from her right eye in the last two months not responded to conservative ophthalmological medications but completely improved on discontinuation dupilumab injection over 6 months followed-up. Conclusions: Conjunctivitis is a well-known adverse effect of Dupilumab injection of a patient with AD. However, persistent conjunctivitis and tearing from the eye not improving on ophthalmology treatment might rule out punctal stenosis and discontinuation of dupilumab should be considered.