Anterior Segment Optical Coherence Tomography (AS-OCT) Guided Reversal of Edematous Punctal Occlusion

Figures & data

Figure 1 Measuring technique: (A) Lower eyelid margin was everted using a cotton bud into a plane perpendicular to the light source. (B) Anterior segment optical coherence tomography (AS-OCT) image showing punctal parameters (outer punctal diameter (OPD), internal punctum and punctal depth (PD)) of a participant in the control group that was measured using anterior segment module of Topcon 3D OCT-2000 ™ (Topcon Medical Systems Inc.).

Table 1 Age and Gender Distribution of the Two Studied Groups

Variable	PEG (n=24 Patients) No. (%)	CG (n=10 Patients) No. (%)	P-value
Gender
Male	3 (12.5)	2 (20.0)	0.573
Female	21 (87.5)	8 (80.0)
Age group
25–34 years	1 (4.1)	1 (10.0)	0.925
35–44 years	3 (12.5)	1 (10.0)
45–54 years	8 (33.3)	3 (30.0)
55–64 years	12 (50.0)	5 (50.0)

Abbreviations: PEG, persistent epiphora group; CG, control group.

Table 2 Comparison of the PEG and the CG Before Treatment Regarding OPD

	PEG (n=40 Eyes) Mean ± SD Range	CG (n=20 Eyes) Mean ± SD Range	P-value
OPD (µm)	455.5 ± 173 206.0–701.0	590.0 ± 106.6 437.0–766.0	0.002

Abbreviations: PEG, persistent epiphora group; CG, control group; OPD, outer punctal diameter.

Figure 2 Epiphora grading by Munk’s score among persistent epiphora group (PEG) before and 1 month after treatment showed significant improvement of epiphora symptoms after treatment.

Table 3 Comparison Between Outer Punctal Diameter (OPD) of Persistent Epiphora Group (PEG) Before Treatment and After Treatment

	Before Treatment	After Treatment	P-value
	Mean ± SD Range	Mean ± SD Range
OPD (µm)	455.5 ± 173 206–701	484.6 ± 175.5 224–730	<0.001

Note: The normal anatomy of the punctum varies greatly and there is scant evidence to aid in the clinical definition of what constitutes punctal stenosis.

Abbreviation: OPD, outer punctal diameter.

Figure 3 (A and B) Before treatment: Slit lamp examination showed barely visible punctum and stuffed appearance. Anterior segment optical coherence tomography (AS-OCT) image revealed outer punctal diameter (OPD) of 280 µm (white line) with lost punctal depth (PD). (C and D) One month after treatment: Slit lamp examination showed decreased punctal edema with clear visible punctal opening. AS-OCT image revealed increased OPD to 480 µm (white line) and restoration of the PD (yellow line) associated with marked clinical improvement.

Figure 4 (A and B) Before treatment: Slit lamp examination showed barely visible punctum. Anterior segment optical coherence tomography (AS-OCT) image revealed outer punctal diameter (OPD) of 443 µm (white line) with very shallow punctal depth (PD). (C) One month after treatment: AS-OCT image revealed minimal increase of OPD to 490 µm (white line) meanwhile neither vertical canaliculus lumen nor inner punctal opening was restored.