Characterizing supernumerary lacrimal punctum by anterior segment optical coherence tomography imaging.

Supernumerary puncta is an uncommon congenital anomaly where multiple puncta are present in one eyelid formed by multiple epithelial budding of lacrimal cord opening along canaliculus, caruncle, and conjunctiva during embryogenesis.[12]

Slit-lamp examinations of left lower lid found presence of two puncta [Fig. 1a] of a 44-year-old gentleman. Spectral domain anterior-segment OCT [SD-ASOCT] imaging of puncta[3] by RTVue model-RT100 CAM -system [Optovue Inc., Fremont CA, USA] showed two funnel shaped tissue gap corresponding cross-sectional image of supernumerary puncta [Fig. 1b]. To the best of our knowledge, this is the first report of AS-OCT of supernumerary puncta in medical literature.

Figure 1

(a) Slit-lamp photography of supernumerary puncta of left eye lower lid, normal healthy puncta [black solid arrow], supernumerary puncta [solid white arrow]. (b) Cross-sectional image of both puncta obtained by AS-OCT, the deep funnel shaped hyporeflective spaces [solid white arrow] is normal healthy puncta. The hyperreflective epithelium of lid margin is continuous in both wall but abruptly thinned out at the margin of opening at temporal wall though nasal wall epithelium maintain its thickness throughout whole vertical depth. The shallow creeping edged tissue gap buried in the lid margin defines supernumerary puncta [asterix]. Here, lid margin epithelium is discontinuous in both the wall

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