Punctal Congestion Syndrome: A Reversible, Functional Punctal Stenosis Causing Epiphora in the Setting of Chronic Pretarsal Conjunctivitis
| Autor: | Christine Zemsky, Yandong Bian, Lora R. Dagi Glass, Thalmon Campagnoli, Stacy M. Scofield-Kaplan, Donald V. Belsito, Larissa Kadar Ghadiali, Bryan J. Winn, B. Sallee |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty medicine.drug_class Punctal stenosis Constriction Pathologic Article Lacrimal Duct Obstruction medicine Humans Prospective Studies Prospective cohort study Retrospective Studies Allergy skin business.industry Retrospective cohort study General Medicine Middle Aged Conjunctivitis Single surgeon Surgery Ophthalmology Loteprednol Chronic Conjunctivitis Corticosteroid Female business medicine.drug |
| Zdroj: | Ophthalmic Plast Reconstr Surg |
| ISSN: | 1537-2677 |
| Popis: | Purpose To describe a reversible syndrome of epiphora, functional punctal stenosis, and chronic pretarsal conjunctivitis associated with corticosteroid or corticosteroid-antibiotic eyedrop use. Methods This is an Institutional Review Board-approved retrospective review of patients diagnosed with epiphora, punctal stenosis, and chronic conjunctivitis by a single surgeon (B.J.W.). These patients were subsequently invited to participate in a prospective study involving allergy skin patch testing for ophthalmic drops, common excipients, and active ingredients. Results Thirteen patients received a diagnosis of punctal congestion syndrome. The average age was 63 years (range, 41-93) and 69.2% were female. Findings were bilateral in 61.5%. All had used preserved drops in the affected eye(s). Various antecedent diagnoses resulted in treatment with preserved drops. Patients experienced epiphora for an average of 3.8 months (median, 3 months; mode, 3 months; range, 1-8 months) prior to presentation. Two patients had undergone punctoplasty which failed to resolve symptoms. 92.3% of patients had been taking tobramycin-dexamethasone drops, loteprednol drops, or a combination of both prior to presentation. All were taken off preserved drops. 69.2% were also treated with a preservative-free loteprednol etabonate 0.5% ophthalmic ointment taper. All improved. Partial relief of symptoms was achieved by an average of 1.6 months (median, 2 months; mode, 2 months; standard deviation, ±0.7 months) and resolution of symptoms by 2.5 months (median, 2 months; mode, 2 months; standard deviation, ±1.7 months). One patient underwent patch testing with strong positive reactions to formaldehyde and neomycin and a weak positive reaction to gentamicin. Conclusions Functional punctal stenosis is associated with topical ophthalmic preparations, especially preserved corticosteroids and antibiotic-corticosteroid combinations. Treatment consists of removal of all preserved eyedrops. Symptoms often improve over several months. |
| Databáze: | OpenAIRE |
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