This is a description of the use of enhanced depth optical coherence tomography (OCT) to see whether a patent ampulla or canaliculus is detectable in patients with absent or occluded puncta. Nine occluded puncta of six patients with epiphora were scanned using an anterior segment module. Four lids of two patients were found to have a definite lumen below the occluded punctum on OCT scanning. This was visible at depths ranging from 126 to 580 microns below the surface. All four of these were later found to have a patent lumen on surgical exploration. Surgical exploration of four of the five remaining puncta where no lumen had been identified on OCT found a patent system in only one case. In this case the OCT had measured to a depth of 773 microns but had not found a lumen, and the authors suggest this may be related to a different, congenital rather than acquired aetiology. The current technology does not allow imaging of the horizontal part of the canaliculus, limiting its usefulness, but where an acquired disease process is likely to affect the punctum rather than the canaliculus OCT scanning appears to have a good predictive value of likely surgical success. 

Characterizing the occluded lacrimal punctum using anterior segment optical coherence tomography.
Timlin HM, Keane PA, Rose GE, Ezra DG.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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