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Immunopathology and histopathology of conjunctival biopsies in patients with presumed idiopathic punctal stenosis
  1. Amit K Reddy1,
  2. Meredith S Baker2,
  3. Amanda C Maltry2,
  4. Nasreen A Syed2,3,
  5. Richard C Allen2,4
  1. 1Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
  2. 2Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  3. 3Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  4. 4Department of Otolaryngology—Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Richard C Allen, Section of Ophthalmology, Department of Head and Neck Surgery, MD Anderson Cancer Center, 1400 Pressler Street, Houston TX 77030, USA;


Background/aims Numerous processes have been implicated as causes of punctal stenosis. Recent studies have highlighted inflammation in punctoplasty specimens in patients with punctal stenosis. Conjunctival biopsy has been suggested as a means to determine underlying aetiologies, although little is known regarding what conjunctival pathologies are associated with punctal stenosis. Our objective is to examine the pathological and immunological findings in conjunctival biopsy specimens in patients with presumed idiopathic punctal stenosis.

Methods A retrospective chart review was performed at a single institution over a 5 year period of patients with presumed idiopathic punctal stenosis who underwent conjunctival biopsy for histopathological and/or direct immunofluorescence (DIF) examination. Patients with known aetiologies of punctal stenosis were excluded.

Results 23 patients met inclusion criteria. Conjunctival biopsies (n=36) from all 23 patients underwent histological examination. 35 specimens (97.2%) showed lymphocytic infiltrates. Two patients (8.7%) had findings suggestive of sarcoidosis. Conjunctival biopsies from 18 of the 23 patients were also evaluated by DIF. Nine patients (50.0%) had fibrinogen characteristics suggestive of lichen planus. There were no complications related to the conjunctival biopsy procedures.

Conclusions Conjunctiva appears to be an excellent proxy in evaluating patients with presumed idiopathic punctal stenosis. The biopsy is safe and provides ample tissue. Clinically, abnormal tissue should be targeted, if available. 11 of the 23 patients in this study demonstrated findings consistent with underlying immunological disorders, suggesting that conjunctival biopsy may play a role in identifying underlying aetiologies of punctal stenosis. Knowledge of these underlying conditions impacted treatments for several patients.

  • Pathology
  • Lacrimal drainage
  • Immunology
  • Conjunctiva
  • Inflammation

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