Isolated Canalicular Pseudoepitheliomatous Hyperplasia: New Disease Description, Clinical Spectrum, Proposed Management, and Outcomes.

Abstract

Purpose: To define the clinical entity of "isolated canalicular pseudoepitheliomatous hyperplasia."

Methods: A retrospective interventional case series that included biopsy-proven cases of pseudoepitheliomatous hyperplasia of the canaliculi. Dacryoendoscopy was performed before the surgical procedure to determine the extent of the lesion. A punctoplasty was performed to access the lesion, followed by an excision biopsy. Parameters assessed include patient demographics, clinical presentation, imaging features, operative techniques, histopathological features, and outcomes.

Results: Four canaliculi of 3 patients presented with canalicular mass lesions with secondary acquired lacrimal drainage obstructions. Epiphora without discharge was the universal presentation. On examination, an elevated pinkish mass lesion was noted to arise from the vertical canalicular walls, filling up the punctal opening without disturbing the integrity of the outer and inner punctal rims (3/4 canaliculi). The surface of the lesion showed either a speckled pigmentation or a membrane-like grayish appearance. One canaliculus presented with noninflammatory and diffuse canalicular swelling clinically mimicking canaliculops. Dacryoendoscopy revealed that the lesion was arising from the vertical canaliculus, not extending beyond the ampulla. A rectangular punctoplasty approach provided good access to achieve complete excision of the lesion. Histopathology confirmed the diagnosis of canalicular pseudoepitheliomatous hyperplasia.

Conclusion: The present study described the clinical spectrum, anterior segment optical coherence tomography, dacryoendoscopy, surgical technique, histopathology, and outcomes of a previously not-recognized entity-"isolated canalicular pseudoepitheliomatous hyperplasia." The study is the first step in further characterizing the clinical and radiological aspects of isolated canalicular pseudoepitheliomatous hyperplasia and improving the surgical techniques.