Supernumerary lacrimal puncta

Abstract

Supernumerary lacrimal punctum is rare, and very few cases have been reported. Most patients are asymptomatic, but in some excessive tearing could be a symptom. In addition, obstruction of the canaliculi causing canaliculitis has been reported. We describe four cases in detail with their presentations and diagnosis. The first patient presented with a right eye lesion and during examination, the left eye was less than mid dilated compared to that of the right eye. Further examination of the left eye revealed two left lower lid puncta. In another patient who was evaluated for diabetic retinopathy, two left lower lid puncta that shared the same canaliculus were noted. Furthermore, two lower lid puncta were found in a patient who came for cataract follow-up. Finally, in a patient who was following up in the retinal clinic, two lower lid puncta were documented. Probing to the accessory punctum showed that the canaliculus had an immediate horizontal course, unlike the rest of the puncta which showed a vertical then a horizontal course. Furthermore, in the accessory punctum, there was a soft stop, around 4 mm of the inserting probe. In summary, supernumerary lacrimal punctum is rare, and ophthalmologists need to be aware of this abnormality.

Supernumerary lacrimal puncta: case series and review of the literature

“…suggested that the right lower lid is the most reported location for the occurrence of supernumerary puncta [ 1 , 6 ]. Thirty-nine patients out of the total 51 patients (76%) were found to have had right lower lid supernumerary puncta which is consistent with previous reports [ 1 , 3 , 5 - 14 ].…”

“…Our case series of four patients showed similar trends, with all four having only double puncta on any one eyelid. It was also consistent with the comprehensive table results which demonstrated the vast majority of patients presenting with double puncta on any one eyelid (98%) and only one patient out of the 51 (2%) with triple puncta in an eyelid that only had intermittent epiphora and no interventions performed [ 1 , 3 , 5 - 14 ]. Forty-six percent of patients (n=23) in the table were reported by Satchi et al .…”

“…We have compiled multiple case series and reports to exhibit trends and potential standardized treatments that may be of benefit to symptomatic double puncta patients ( Table 1 ). In the table, there were a total of 51 patients with supernumerary puncta including the four patients in our case series [ 1 , 3 , 5 - 14 ]. There were a total of 27 female (53%) and 24 male (47%) patients.…”

“…Although accessory lacrimal puncta can be asymptomatic, a variety of symptoms have been attributed to the presence of double puncta including but not limited to dry eyes, epiphora, and canaliculitis [ 1 , 3 , 5 - 14 ] In this discussion, we will describe each of the three associated symptoms and their potential causes.…”

“…It may begin with an irregular budding of the ectodermal core, which invades the mesoderm of the lid and becomes what is known as the lacrimal puncta-canaliculi [ 1 ]. Double lacrimal puncta are mostly asymptomatic, however, epiphora, dry eyes, and canaliculitis have been reported to be associated with these anomalies [ 1 , 3 , 5 - 14 ]. These findings can be easily missed during a routine ocular examination; thus, careful slit lamp examination is highly recommended to detect these anomalies.…”