Lacrimal Pathologies and Optical Coherence Tomography

Abstract

Ocular coherence tomography is being increasingly utilized to study disorders of the proximal lacrimal drainage system [1–5]. OCT can be useful for diagnosis and monitoring treatments for numerous conditions like the punctal stenosis, punctal agenesis, incomplete punctal canalization, punctal keratinizing cyst, and canaliculus. Typical FD-OCT features described for IPC include a hyper-reflective membrane covering the punctal surface with distinctly identifiable and normal lumen of the vertical canaliculus beneath. Membranotomy is the preferred modality of managing IPC with very high success rates where normal appearing wide punctum can be seen on OCT. Punctal stenosis is characterized by near total or complete closure at the level of internal punctum with very narrow vertical canaliculus or no visualization of underlying canaliculus. Typical FD-OCT features in a case of punctal keratinizing cysts include an obliterated punctal opening with a hyper-reflective lesion extending into the vertical canaliculus. Hyper-reflectivity is attributed to the presence of keratin. FD-OCT in a case of canaliculus demonstrates a dilated canaliculus with empty lumen surrounded by a well-defined cyst wall.