Presumed Virus-Induced Punctal Occlusion

Purpose. To investigate viral infection as a cause of punctal stenosis in individuals without any ocular or systemic risk factors. Methods. The study group comprised patients with no known cause for punctal occlusion who underwent surgery at one medical center during a one-year period. Excised tissue was subjected to histological examination, PCR, and nested PCR testing for common viruses (adenovirus, influenza A and B, enterovirus, varicella-zoster, CMV, herpes simplex types 1 and 2, Epstein-Barr virus, and parainfluenza type 1). Results. All nine patients identified were female, 20–38 years of age. The three-snip-procedure resolved tearing in eight of them. All excised samples showed chronic mononuclear inflammation compatible with viral infection or with viral infection immune inflammatory reaction. PCR testing was negative for all the viruses examined; however, nested PCR was positive in three patients. Conclusion. This study supports the proposition that punctal occlusion in young healthy females may be due to viral infection. 1. Introduction Punctal disorders are usually secondary to inflammation, infection, disuse, trauma, or medications. The punctum can be totally obliterated or stenotic. In herpes keratoconjunctivitis, the punctum and canaliculus may become stenotic [1]. In cases of longstanding ectropion or punctal ectropion alone, the punctal orifice may become stenotic or obliterated. The punctum may be occluded in systemic and ocular chronic graft-versus-host disease [2] and secondary to the usage of antineoplastic agents such as docetaxel (taxotere), as well as in patients with metastatic breast cancer [3] or chronic blepharitis [4]. Punctal or canaliculus occlusion may be associated with the use of certain topical ocular medications, including pilocarpine, phenylephrine hydrochloride, timolol maleate, indomethacin, and others, with a duration of exposure ranging from 3 weeks to 20 years [5]. In this study we examined the phenomenon of punctal occlusion or stenosis in young healthy patients without any ocular or systemic risk factors. We investigated the possibility that viral infections may be causal agents of chronic inflammation that results in punctual stenosis. 2. Patients and Methods Patients suffering from epiphora who were operated due to unilateral or bilateral punctal occlusion at our ophthalmology clinic during the period from May 2011 to June 2012 were included in this study. Exclusion criteria were as follows: below 18 years of age, chronic eye disease (cataract, glaucoma, uveitis, blepharitis, allergic conjunctivitis, and