Supernumerary Puncta: An Uncommon Underdiagnosed Cause of Unilateral Epiphora

Abstract

Introduction The presence of multiple eyelid puncta is known as supernumerary puncta. The presence of supernumerary puncta is caused by lacrimal outflow dysgenesis and can result in unilateral epiphora. Although an infrequent diagnosis, supernumerary puncta should be considered in the differential diagnosis of unilateral epiphora to allow for the correct management of patient’s symptoms. Case Report A 74-year-old white male presented with a chief complaint of unilateral epiphora of his right eye. The presence of two puncta on the inferior lid margin of one eye was noted. Further evaluation with anterior segment optical coherence tomography (OCT) revealed that both puncta were functional. Occlusion of the accessory punctum and use of artificial tears four times a day was the treatment which led to the resolution of his symptoms. Conclusion Through a careful examination and assessment, the root cause of epiphora can be determined, and the appropriate management can be pursued. Although not exceptionally rare, supernumerary puncta may be present and cause epiphora through lacrimal outflow dysgenesis. Supernumerary puncta can be identified easily with careful slit lamp examination. Probing of the punctum and anterior segment OCT can be used to identify the accessory punctum and determine its functionality.