A preliminary study on the clinical characteristics of lacrimal duct obstruction in patients with a history of anterior uveitis.

Abstract

Aim: This study aimed to investigate the clinical features of lacrimal duct obstruction (LDO) in patients with a history of anterior uveitis (AU) and explore preventive strategies by analyzing their demographic, anatomical, and surgical outcome profiles.

Methods: We retrospectively reviewed 40 LDO patients (58 eyes) with a history of AU, treated between 2020 and 2024, comparing them to non-AU LDO controls. Data included demographics, AU-epiphora temporal relationships, obstruction characteristics (location, extent, and adhesions), and surgical outcomes. Statistical analysis evaluated differences between groups.

Results: The mean age was 49.88 ± 10.18 years, with 30 women (75%) and 10 men (25%). Proximal lacrimal canalicular obstruction (<4 mm from lacrimal punctum) occurred in 32 cases (80%), comprising 16 cases of lacrimal punctal atresia, 6 cases of proximal lacrimal canalicular obstruction, and 10 cases with a combination of both conditions. Additional cases included one (2.5%) middle lacrimal canalicular obstruction and two (5%) distal lacrimal canalicular obstructions. In total, three (7.5%) had proximal and distal lacrimal canalicular obstructions, one (2.5%) had proximal and middle lacrimal canalicular obstruction, and one (2.5%) had middle and distal lacrimal canalicular obstruction. Among 11 patients with ankylosing spondylitis, the onset of AU averaged 10.02 ± 9.34 years, with epiphora preceding uveitis by an average of 3.24 ± 3.42 years. Intraoperatively, 32 patients (80%) showed extensive adhesive LDO. Surgical procedures included laser canaliculoplasty with lacrimal stent intubation (55 eyes), dacryocystorhinostomy with lacrimal stent intubation (one eye), and retrograde canalicular trephination combined with dacryocystorhinostomy and lacrimal stent intubation (two eyes). Treatment outcomes showed a complete cure in 8 cases (20%), improvement in 21 cases (52.5%), and no effect in 11 cases (27.5%). The surgical success rates were significantly lower in uveitis patients compared to controls (p < 0.001), with extensive adhesions observed intraoperatively in 80% of uveitis cases.

Conclusion: In patients with a history of AU, LDO predominantly affects the proximal lacrimal structures, often resulting in severe adhesions and poor surgical outcomes, with a cure rate of only 20%. The temporal link between epiphora and AU onset suggests shared pathophysiology. Targeted research is critical to clarify AU-LDO mechanisms and optimize prevention.