[Diagnostic capabilities of optical coherence tomography in obstruction of the upper lacrimal pathway].

An objective assessment of the lacrimal punctum (LP) and peripunctal area, essential for appropriate treatment planning, is only possible through optical coherence tomography (OCT). To date, global experience with this method remains limited, underscoring the need for further investigation of its diagnostic value.

Purpose: This study evaluated the diagnostic capabilities of OCT in cases of obstruction of the upper lacrimal pathway.

Material and methods: The study included 26 patients (39 LP and canaliculi) with epiphora, in whom stenosis or obliteration of the LP by a membranous structure was identified. All patients underwent OCT of the LP and lacrimal canaliculus (LC) using the SD-OCT Optovue RTVue-100 system. The following morphological parameters were assessed: external LP diameter, LP depth, depth of the tear well, thickness of the epithelial, connective tissue, and muscle layers in the peripunctal area, epithelial thickness and lumen width of lacrimal canaliculus, as well as the thickness of the LP membrane. Histological structure, location, membrane thickness, and degree of canalicular lumen obstruction were also evaluated. Comparative and correlation analyses were performed.

Results: The following types of membranes have been identified: thick, complete, superficial epithelial-connective tissue membrane (33%); thin, complete, deep epithelial membrane (23%); and thick, complete, superficial epithelial membrane (15%). The most pronounced differences were found when comparing epithelial and epithelial-connective tissue membranes. Some OCT signs were found to be potential markers of ocular surface inflammation and inflammation of the upper lacrimal pathway, indicating a need for conservative etiopathogenetic therapy before surgical intervention.

Conclusion: OCT is a valuable diagnostic tool, and its findings may serve as the foundation for developing rational approaches to both conservative and surgical treatment in patients with idiopathic inflammation of the LP and LC, as well as with stenosis or obliteration of the upper lacrimal pathway.