Caruncle and plica hypertrophy causing mechanical secondary acquired lacrimal duct obstruction: – SALDO update study (SUP) – paper I

ABSTRACT

Purpose

To exclusively report the clinical category of mechanical secondary acquired lacrimal duct obstruction (SALDO) secondary to the caruncle and plica hypertrophy.

Methods

Prospective interventional case series involving 10 consecutive eyes with megalocaruncle and plica hypertrophy were enrolled in the study. All patients presented with epiphora secondary to a demonstratable mechanical obstruction of the puncta. All patients underwent high magnification slit-lamp photography and Fourier-domain ocular coherence tomography scans (FD-OCT) of the tear meniscus height (TMH) pre- and post-operatively at 1-month and 3-months. Caruncle and plica size, position, and their relationship to the puncta were noted. All patients underwent partial carunculectomy. Primary outcome measures were demonstrable resolution of the mechanical obstruction of the puncta and the reduction in the tear meniscus height. The secondary outcome measure was the subjective improvement of the epiphora.

Results

The mean age of the patients was 67 years (range: 63–72 years). The average TMH was 843.1 (range: 345–2049) microns pre-operatively and 195.1(91–379) microns at 1-month follow-up. All patients reported significant subjective improvement in epiphora at 6-months follow-up. One patient had bilateral granuloma at the surgical site at two weeks and was managed by simple excision and topical tapering steroids. Histopathology revealed hyperplastic epithelium with goblet cells with chronic inflammatory cells in the sub-epithelial region and the stroma.

Conclusion

The role of the caruncle in the causation of mechanical SALDO needs to be carefully assessed in patients beyond the sixth decade. Excellent objective and subjective outcomes can be achieved by a partial carunculectomy and plica semilunaris excision.

KEYWORDS:

• Mechanical secondary acquired lacrimal duct obstruction
• functional epiphora
• caruncle
• plica semilunaris
• SALDO
• lacrimal

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Funding

The work was supported by Hyderabad Eye Research Foundation. MJA receives royalties from Springer for his treatise ‘Principles and Practice of Lacrimal Surgery’, and ‘Atlas of Lacrimal Drainage Disorders’, and ‘Video Atlas of Lacrimal Drainage Surgery’.