Abstract
Purpose
To evaluate the prevalence of the obstruction of lacrimal drainage system (LDS) in patients with pseudoexfoliation (PXF) syndrome.
Materials and Methods
This cross-sectional study included 152 eyes of 76 consecutive patients with bilateral PXF syndrome and 170 eyes of 85 age and gender-matched controls. The LDS evaluation was performed based on dye disappearance test, slit-lamp examination, diagnostic probing, and irrigation test. The presence of punctal stenosis and canalicular obstruction were considered as the obstruction of proximal LDS; and complete or incomplete nasolacrimal duct obstruction was considered as obstruction of distal LDS. Demographic characteristics, ophthalmologic findings, and prevalence and site of obstruction of LDS were compared among the groups.
Results
The prevalence of obstruction of LDS was higher in the PXF syndrome group when compared to controls (21.1% vs 12.2%), but the difference was not statistically significant (p = 0.061). The obstruction of proximal LDS was found to be more frequent in the PXF syndrome (17.7%) group when compared to controls (10.0%), and this difference was statistically significant (p = 0.041). There was significantly more punctal stenosis in the PXF syndrome group when compared to controls (15.1% vs 7.6%, p = 0.033). The prevalence of canalicular stenosis and obstruction of distal LDS was similar in the PXF and the control groups (p = 0.596 and p = 0.741, respectively).
Conclusion
The prevalence of punctal stenosis was statistically significantly higher in the PXF syndrome group when compared to the controls. This association is probably related to increased local ocular surface inflammation which is triggered by the accumulation of PXF material.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Das AV, Rath S, Naik MN, Ali MJ. The Incidence of lacrimal drainage disorders across a tertiary eye care network: Customization of an indigenously developed electronic medical record system-eyeSmart. Ophthalmic Plast Reconstr Surg. 2019;35:354–6.
Fiorino MG, Quaranta-Leoni C, Quaranta-Leoni FM Proximal lacrimal obstructions: a review. Acta Ophthalmol. (2021). https://doi.org/10.1111/aos.14762.
Schaefer DP Acquired etiologies of lacrimal system obstructions. In: Cohen A, Mercandetti M, Brazzo B (eds). The Lacrimal System. (Springer: Cham, 2015) 43–68.
Ali MJ Disorders of the upper lacrimal system. In: Ali M (eds). Principles and practice of lacrimal surgery. (Springer: Singapore, 2018) 135–40.
Starks VS, Yoon MK. Acquired obliteration of the proximal lacrimal drainage system. Ophthalmic Plast Reconstr Surg. 2019;35:342–5.
Pakdel F, Bahmani Kashkouli M. Lacrimal drainage obstruction associated with topical and systemic medications. J Ophthalmic Vis Res. 2009;4:270–1.
Schlötzer-Schrehardt U, Naumann GO. Ocular and systemic pseudoexfoliation syndrome. Am J Ophthalmol. 2006;141:921–37.
Ritch R. Ocular and systemic manifestations of exfoliation syndrome. J Glaucoma. 2014;23:S1–8.
Dursun F, Vural Ozec A, Aydin H, Topalkara A, Dursun A, Toker MI, et al. Total oxidative stress, paraoxonase and arylesterase levels at patients with pseudoexfoliation syndrome and pseudoexfoliative glaucoma. Int J Ophthalmol. 2015;8:985–90.
Tetikoglu M, Sagdik HM, Aktas S, Uçar F, Özcura F. Serum prolidase activity and oxidative stress in patients with pseudoexfoliation syndrome. Graefes Arch Clin Exp Ophthalmol. 2016;254:1339–43.
Yildirim Z, Yildirim F, Uçgun NI, Sepici-Dinçel A. The role of the cytokines in the pathogenesis of pseudoexfoliation syndrome. Int J Ophthalmol. 2013;6:505–3.
Schlötzer-Schrehardt U, Küchle M, Naumann GO. Electron-microscopic identification of pseudoexfoliation material in extrabulbar tissue. Arch Ophthalmol. 1991;109:565–70.
Öncel BA, Pinarci E, Akova YA. Tear osmolarity in unilateral pseudoexfoliation syndrome. Clin Exp Optom. 2012;95:506–9.
Kashkouli MB, Beigi B, Murthy R, Astbury N. Acquired external punctal stenosis: etiology and associated findings. Am J Ophthalmol. 2003;136:1079–84.
Hur MC, Jin SW, Roh MS, Jeong WJ, Ryu WY, Kwon YH, et al. Classification of lacrimal punctal stenosis and its related histopathological feature in patients with epiphora. Korean J Ophthalmol. 2017;31:375–82.
Ali MJ, Mishra DK, Baig F, Lakshman M, Naik MN. Punctal stenosis: histopathology, immunology, and electron microscopic features-a step toward unraveling the mysterious etiopathogenesis. Ophthalmic Plast Reconstr Surg. 2015;31:98–102.
Port AD, Chen YT, Lelli GJ Jr. Histopathologic changes in punctal stenosis. Ophthalmic Plast Reconstr Surg. 2013;29:201–4.
Jang JK, Lee SM, Lew H. A histopathological study of lacrimal puncta in patients with primary punctal stenosis. Graefes Arch Clin Exp Ophthalmol. 2020;258:201–7.
Reddy AK, Baker MS, Maltry AC, Maltry AC, Syed NA, Allen RC. Immunopathology and histopathology of conjunctival biopsies in patients with presumed idiopathic punctal stenosis. Br J Ophthalmol. 2017;101:213–7.
Botling Taube A, Konzer A, Alm A, Bergquist J. Proteomic analysis of the aqueous humour in eyes with pseudoexfoliation syndrome. Br J Ophthalmol. 2019;103:1190–4.
Ferreira SM, Lerner SF, Brunzini R, Evelson PA, Llesuy SF. Antioxidant status in the aqueous humour of patients with glaucoma associated with exfoliation syndrome. Eye. 2009;23:1691–7.
Schlötzer-Schrehardt U. Oxidative stress and pseudoexfoliation glaucoma. Klin Monbl Augenheilkd. 2010;227:108–13.
Kozobolis VP, Detorakis ET, Tsopakis GM, Pallikaris IG. Evaluation of tear secretion and tear film stability in pseudoexfoliation syndrome. Acta Ophthalmol Scand. 1999;77:406–9.
Kozobolis VP, Christodoulakis EV, Naoumidi II, Siganos CS, Detorakis ET, Pallikaris LG. Study of conjunctival goblet cell morphology and tear film stability in pseudoexfoliation syndrome. Graefes Arch Clin Exp Ophthalmol. 2004;242:478–83.
Erdoğan H, Arici DS, Toker MI, Arici MK, Fariz G, Topalkara A. Conjunctival impression cytology in pseudoexfoliative glaucoma and pseudoexfoliation syndrome. Clin Exp Ophthalmol. 2006;34:108–13.
Luo L, Li DQ, Pflugfelder SC. Hyperosmolarity–induced apoptosis in human corneal epithelialcells is mediated by cytochrome c and MAPK pathways. Cornea. 2007;26:452–60.
Luo L, Li DQ, Doshi A, Farley W, Corrales RM, Pflugfelder SC. Experimental dry eye stimulates production of inflammatory cytokines and MMP-9 and activates MAPK signaling pathways on the ocular surface. Invest Ophthalmol Vis Sci. 2004;45:4293–301.
Fogagnolo P, Torregrossa G, Tranchina L, Ferreras A, De Cillá S, Labbé A, et al. Tear film osmolarity, ocular surface disease and glaucoma: a review. Curr Med Chem. 2019;26:4241–52.
Berlau J, Lorenz P, Beck R, Makovitzky J, Schlötzer-Schrehardt U, Thiesen HJ, et al. Analysis of aqueous humour proteins of eyes with and without pseudoexfoliation syndrome. Graefes Arch Clin Exp Ophthalmol. 2001;239:743–6.
Can Demirdöğen B, Demirkaya-Budak S, Özge G, Mumcuoğlu T. Evaluation of tear fluid and aqueous humor concentration of clusterin as biomarkers for early diagnosis of pseudoexfoliation syndrome and pseudoexfoliative glaucoma. Curr Eye Res. 2020;45:805–13.
Kashkouli MB, Rezaee R, Nilforoushan N, Salimi S, Foroutan A, Naseripour M. Topical antiglaucoma medications and lacrimal drainage system obstruction. Ophthalmic Plast Reconstr Surg. 2008;24:172–5.
Kashkouli MB, Pakdel F, Hashemi M, Ghaempanah MJ, Rezaee R, Kaghaz-Kanani R, et al. Comparing anatomical pattern of topical anti-glaucoma medications associated lacrimal obstruction with a control group. Orbit. 2010;29:65–69.
Ortiz-Basso T, Galmarini A, Vigo RL, Gonzalez-Barlatay JM, Premoli EJ. The relationship between topical anti-glaucoma medications and the development of lacrimal drainage system obstruction. Arq Bras Ophtalmol. 2018;81:490–3.
Author information
Authors and Affiliations
Contributions
All mentioned authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by FCE and MAS. The first draft of the manuscript was written by FCE, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethics approval
Local ethics committee approval was received for the study (Ankara Training and Research Hospital, Ankara, Turkey; project registration number: E-21-675). All protocols adhered to the Declaration of Helsinki.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Eroglu, F.C., Sekeroglu, M.A., Ceran, T.H. et al. Evaluation of lacrimal drainage system in Pseudoexfoliation syndrome. Eye 36, 2094–2098 (2022). https://doi.org/10.1038/s41433-021-01799-1
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/s41433-021-01799-1
