Lacrimal Punctal Atresia

Punctal atresia is the most frequently diagnosed congenital anomaly. It may affect the superior, inferior, or both puncta, and it may be either unilateral or bilateral (Figure 9.4). It occurs in numerous breeds and is commonly seen in American Cocker Spaniels, Bedlington Terriers, Golden Retrievers, Miniature and Toy Poodles, and Samoyeds.

The diagnosis is confirmed by biomicroscopic examination and normograde or retrograde nasolacrimal duct flushing. Superior punctal atresia is asymptomatic and is diagnosed incidentally during routine biomicroscopic examinations. When inferior punctal atresia is present, epiphora is usually present in puppies, and nasolacrimal flushing is warranted. The conjunctiva over the canaliculus will bulge during flushing. Ventral punctal atresia is treated by surgical excision of the ballooning conjunctiva (Figure 9.5A, B). The affected eye is then treated with topical antibiotic and corticosteroid solutions four times a day for 7-10 days until the punctum is patent and epiphora is absent.

Figure 9.5. Ventral punctual atresia. Note the ballooning of the conjunctiva over the aplastic punctum (A) during a normograde nasolacrimal flush through the superior punctum. The ballooning conjunctiva is excised with scissors (B) to create a new punctum.

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