Double puncta canaliculi may exhibit different clinical presentations

ABSTRACT In this paper, we describe two adult patients who presented with double lacrimal puncta: one of them was asymptomatic and incidentally diagnosed, and the other complained of epiphora. In both patients, unilaterality, preference for the lower lid, and location medial to the normal punctum were common features of the accessory punctum. In the asymptomatic patient, irrigation revealed no obstruction in the punctum or the nasolacrimal drainage system. By contrast, the other patient’s nasolacrimal drainage system exhibited obstruction. Therefore, dacryocystorhinostomy surgery and silicone tube intubation were successfully performed. Double lacrimal puncta may be associated with epiphora or dry eye. These manifestations can easily be missed in a routine examination. This report was written to emphasize that unilateral epiphora of dry eye symptoms may be related to supernumerary punctum or canalicular systems and can easily be diagnosed with lid eversion.

摘要 本文报道2例表现为双泪小点（lacrimal puncta）的成年患者：1例无自觉症状，为偶然确诊；另1例主诉溢泪。2例患者的副泪小点（accessory punctum）均具有单侧性、好发于下睑、位于正常泪小点内侧的共同特征。无症状患者经泪道冲洗检查显示，其泪小点及鼻泪引流系统（nasolacrimal drainage system）无阻塞；与之相反，另1例患者的鼻泪引流系统存在阻塞，遂为其成功实施了泪囊鼻腔吻合术（dacryocystorhinostomy）与硅胶管插管术。双泪小点畸形可伴发溢泪或干眼症（dry eye），此类表现在常规眼科检查中极易被漏诊。撰写本病例报告旨在强调：单侧溢泪伴干眼症症状可能与额外泪小点（supernumerary punctum）或泪小管系统异常相关，且通过翻转眼睑即可轻松确诊。