Atkova E L, Yartsev V D, Kulish K K, Zhukov O V, Pak A V
Krasnov Research Institute of Eye Diseases, Moscow, Russia.
I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Vestn Oftalmol. 2025;141(3):37-47. doi: 10.17116/oftalma202514103137.
An objective assessment of the lacrimal punctum (LP) and peripunctal area, essential for appropriate treatment planning, is only possible through optical coherence tomography (OCT). To date, global experience with this method remains limited, underscoring the need for further investigation of its diagnostic value.
This study evaluated the diagnostic capabilities of OCT in cases of obstruction of the upper lacrimal pathway.
The study included 26 patients (39 LP and canaliculi) with epiphora, in whom stenosis or obliteration of the LP by a membranous structure was identified. All patients underwent OCT of the LP and lacrimal canaliculus (LC) using the SD-OCT Optovue RTVue-100 system. The following morphological parameters were assessed: external LP diameter, LP depth, depth of the tear well, thickness of the epithelial, connective tissue, and muscle layers in the peripunctal area, epithelial thickness and lumen width of lacrimal canaliculus, as well as the thickness of the LP membrane. Histological structure, location, membrane thickness, and degree of canalicular lumen obstruction were also evaluated. Comparative and correlation analyses were performed.
The following types of membranes have been identified: thick, complete, superficial epithelial-connective tissue membrane (33%); thin, complete, deep epithelial membrane (23%); and thick, complete, superficial epithelial membrane (15%). The most pronounced differences were found when comparing epithelial and epithelial-connective tissue membranes. Some OCT signs were found to be potential markers of ocular surface inflammation and inflammation of the upper lacrimal pathway, indicating a need for conservative etiopathogenetic therapy before surgical intervention.
OCT is a valuable diagnostic tool, and its findings may serve as the foundation for developing rational approaches to both conservative and surgical treatment in patients with idiopathic inflammation of the LP and LC, as well as with stenosis or obliteration of the upper lacrimal pathway.
泪小点（LP）及泪小点周围区域的客观评估对于制定恰当的治疗方案至关重要，而这只有通过光学相干断层扫描（OCT）才能实现。迄今为止，该方法的全球应用经验仍然有限，这凸显了进一步研究其诊断价值的必要性。
本研究评估了OCT在上泪道阻塞病例中的诊断能力。
本研究纳入了26例有溢泪症状的患者（39个泪小点和泪小管），其中发现泪小点被膜性结构狭窄或闭塞。所有患者均使用SD-OCT Optovue RTVue-100系统对泪小点和泪小管（LC）进行OCT检查。评估了以下形态学参数：泪小点外部直径、泪小点深度、泪池深度、泪小点周围区域上皮、结缔组织和肌肉层的厚度、泪小管上皮厚度和管腔宽度，以及泪小点膜的厚度。还评估了组织学结构、位置、膜厚度和泪小管管腔阻塞程度。进行了比较和相关性分析。
已识别出以下几种类型的膜：厚的、完整的、浅表上皮-结缔组织膜（33%）；薄的、完整的、深部上皮膜（23%）；以及厚的、完整的、浅表上皮膜（15%）。在比较上皮膜和上皮-结缔组织膜时发现了最显著的差异。发现一些OCT征象是眼表炎症和上泪道炎症的潜在标志物，这表明在手术干预前需要进行保守的病因治疗。
OCT是一种有价值的诊断工具，其检查结果可为制定针对特发性泪小点和泪小管炎症以及上泪道狭窄或闭塞患者的保守和手术治疗的合理方法提供依据。
