Lacrimal Clinic, Moorfields Eye Hospital, London, United Kingdom.
NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, United Kingdom.
Ophthalmic Plast Reconstr Surg. 2019 Nov/Dec;35(6):549-552. doi: 10.1097/IOP.0000000000001368.
To characterize the anatomical anomaly of congenital double puncta, identify factors contributing to epiphora and its treatment.
Retrospective review of patients presenting with epiphora and a double lacrimal punctum over a 6-month period.
Five consecutive patients (3 female) were identified. The median age was 50 years (range 34-76). Investigations included punctum optical coherence tomography, dacryocystography, and canalicular endoscopy. The medial punctum was more morphologically abnormal when compared with healthy puncta, with optical coherence tomography showing no vertical canalicular component in 80% (4/5) of patients, and a more superficial than usual horizontal canaliculus in 80% (4/5). Dacryocystography and canalicular endoscopy showed the junction of the 2 inferior canaliculi, which was very proximal in 1, mid canalicular in 2, and at the level of the common canaliculus in 2. In 1 patient, the only abnormality identified was the double lower punctum, with a high tear meniscus and delayed fluorescence dye disappearance test. They underwent endonasal dacryocystorhinostomy with improvement of epiphora. In the other 4 patients, causes of epiphora were nasolacrimal duct stenosis with mucocoele, punctal stenosis, common canalicular stenosis with nasolacrimal duct stenosis, upper canaliculitis, and blepharitis. Their treatments included endonasal dacryocystorhinostomy, punctoplasty, canaliculotomy, and blepharitis treatment. All had improvement of epiphora following treatment.
These findings suggest that the underlying canalicular anomalies are varied and that the clinical manifestation is also heterogenous. Optical coherence tomography imaging suggests that the medial of the 2 puncta is the more morphologically abnormal one, with dacryocystography and canalicular endoscopy demonstrating different accessory canaliculi lengths.Double puncta coexist with a range of other nasolacrimal pathologies. OCT suggests that the medial of the 2 double puncta is the abnormal one, with DCG and endoscopy demonstrating a range of accessory canaliculus lengths.
描述先天性双泪点的解剖异常，确定导致溢泪的因素及其治疗方法。
对 6 个月内出现溢泪和双泪点的患者进行回顾性分析。
连续 5 例患者（3 例女性）被确定。中位年龄为 50 岁（范围 34-76 岁）。检查包括泪点光学相干断层扫描、泪道造影和泪小管内窥镜检查。与健康泪点相比，内侧泪点的形态更为异常，80%（4/5）的患者泪点光学相干断层扫描显示无垂直泪小管成分，80%（4/5）的患者水平泪小管比通常的更浅。泪道造影和泪小管内窥镜检查显示 2 条下泪小管的交界处，其中 1 例非常靠近鼻内，2 例位于泪小管中部，2 例位于共同泪小管水平。在 1 例患者中，唯一的异常是双下泪点，泪膜高，荧光染料消失试验延迟。他们接受了鼻内泪囊鼻腔吻合术，溢泪得到改善。在另外 4 例患者中，溢泪的原因是鼻泪管狭窄伴黏液囊肿、泪点狭窄、共同泪小管狭窄伴鼻泪管狭窄、上泪小管炎和睑缘炎。他们的治疗包括鼻内泪囊鼻腔吻合术、泪点成形术、泪小管切开术和睑缘炎治疗。所有患者的溢泪症状在治疗后均得到改善。
这些发现表明，潜在的泪小管异常是多种多样的，临床表现也是多种多样的。泪点光学相干断层扫描成像表明，两个泪点的内侧形态更为异常，泪道造影和泪小管内窥镜检查显示不同的辅助泪小管长度。双泪点与一系列其他鼻泪管疾病并存。OCT 提示两个双泪点中的内侧是异常的，而 DCG 和内窥镜检查则显示出一系列辅助泪小管的长度。
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