Immunopathology and histopathology of conjunctival biopsies in patients with presumed idiopathic punctal stenosis

Amit K. Reddy, Meredith S. Baker, Amanda C. Maltry, Nasreen A. Syed, Richard C. Allen

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)213-217
Number of pages5
JournalBritish Journal of Ophthalmology
Volume101
Issue number2
DOIs
StatePublished - Feb 1 2017

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Pathologic Constriction
Biopsy
Direct Fluorescent Antibody Technique
Lichen Planus
Conjunctiva
Proxy
Sarcoidosis
Fibrinogen
Pathology
Inflammation

Keywords

  • Conjunctiva
  • Immunology
  • Inflammation
  • Lacrimal drainage
  • Pathology

Cite this

Immunopathology and histopathology of conjunctival biopsies in patients with presumed idiopathic punctal stenosis. / Reddy, Amit K.; Baker, Meredith S.; Maltry, Amanda C.; Syed, Nasreen A.; Allen, Richard C.

In: British Journal of Ophthalmology, Vol. 101, No. 2, 01.02.2017, p. 213-217.

Research output: Contribution to journalArticle

Reddy, Amit K. ; Baker, Meredith S. ; Maltry, Amanda C. ; Syed, Nasreen A. ; Allen, Richard C. / Immunopathology and histopathology of conjunctival biopsies in patients with presumed idiopathic punctal stenosis. In: British Journal of Ophthalmology. 2017 ; Vol. 101, No. 2. pp. 213-217.
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abstract = "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.",
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