Immunopathology and histopathology of conjunctival biopsies in patients with presumed idiopathic punctal stenosis

Amit K Reddy; Meredith S Baker; Amanda C Maltry; Nasreen A Syed; Richard C Allen

doi:10.1136/bjophthalmol-2015-308291

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Immunopathology and histopathology of conjunctival biopsies in patients with presumed idiopathic punctal stenosis

Journal article

Open access

Peer reviewed

Immunopathology and histopathology of conjunctival biopsies in patients with presumed idiopathic punctal stenosis

Amit K Reddy, Meredith S Baker, Amanda C Maltry, Nasreen A Syed and Richard C Allen

British journal of ophthalmology, Vol.101(2), pp.213-217

02/2017

DOI: 10.1136/bjophthalmol-2015-308291

PMCID: PMC5195914

PMID: 27073206

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Abstract

Numerous processes have been implicated as causes of punctal stenosis. Recent studies have highlighted inflammation in punctoplasty specimens in patients with punctal stenosis. Conjunctival biopsy has been suggested as a means to determine underlying aetiologies, although little is known regarding what conjunctival pathologies are associated with punctal stenosis. Our objective is to examine the pathological and immunological findings in conjunctival biopsy specimens in patients with presumed idiopathic punctal stenosis. A retrospective chart review was performed at a single institution over a 5 year period of patients with presumed idiopathic punctal stenosis who underwent conjunctival biopsy for histopathological and/or direct immunofluorescence (DIF) examination. Patients with known aetiologies of punctal stenosis were excluded. 23 patients met inclusion criteria. Conjunctival biopsies (n=36) from all 23 patients underwent histological examination. 35 specimens (97.2%) showed lymphocytic infiltrates. Two patients (8.7%) had findings suggestive of sarcoidosis. Conjunctival biopsies from 18 of the 23 patients were also evaluated by DIF. Nine patients (50.0%) had fibrinogen characteristics suggestive of lichen planus. There were no complications related to the conjunctival biopsy procedures. Conjunctiva appears to be an excellent proxy in evaluating patients with presumed idiopathic punctal stenosis. The biopsy is safe and provides ample tissue. Clinically, abnormal tissue should be targeted, if available. 11 of the 23 patients in this study demonstrated findings consistent with underlying immunological disorders, suggesting that conjunctival biopsy may play a role in identifying underlying aetiologies of punctal stenosis. Knowledge of these underlying conditions impacted treatments for several patients.

Immunohistochemistry

Complement C3 - analysis

Eyelid Diseases - pathology

Conjunctiva - immunology

Humans

Middle Aged

Histiocytes - pathology

Male

Immunoglobulins - analysis

Conjunctiva - pathology

Lymphocytes - pathology

Biopsy

Eyelid Diseases - diagnosis

Eyelid Diseases - immunology

Fibrinogen - analysis

Aged, 80 and over

Adult

Female

Aged

Retrospective Studies

Neutrophils - pathology

Details

Title: Subtitle: Immunopathology and histopathology of conjunctival biopsies in patients with presumed idiopathic punctal stenosis
Creators: Amit K Reddy - Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
Meredith S Baker - Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Amanda C Maltry - Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Nasreen A Syed - Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Richard C Allen - Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Resource Type: Journal article
Publication Details: British journal of ophthalmology, Vol.101(2), pp.213-217
DOI: 10.1136/bjophthalmol-2015-308291
PMID: 27073206
PMCID: PMC5195914
NLM abbreviation: Br J Ophthalmol
ISSN: 0007-1161
eISSN: 1468-2079
Publisher: England
Grant note: T35 HL007485 / NHLBI NIH HHS
Language: English
Date published: 02/2017
Academic Unit: Pathology; Ophthalmology and Visual Sciences
Record Identifier: 9983979969002771

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