PXS patients are more likely to experience LDS obstruction. Photo: Aaron Bronner, OD.
PXS patients are more likely to experience LDS obstruction. Photo: Aaron Bronner, OD. Click image to enlarge.

The association between pseudoexfoliation syndrome (PXS) and ocular problems like glaucoma, keratopathy, zonulopathy, cataracts and dry eye is fairly well known. A new study reports this condition may also put patients at a higher risk for proximal lacrimal drainage system (LDS) obstruction. The investigative team from Turkey attributed this high LDS prevalence to local chronic inflammation triggered by the accumulation of PXS material.

“Physicians should be aware of this relationship for the early diagnosis and timely treatment of obstruction of LDS for prevention of the need for late lacrimal surgery,” the authors wrote in their paper.

The cross-sectional study included 152 eyes of 76 patients with bilateral PXS and 170 eyes of 85 age- and gender-matched controls. The researchers conducted the LDS evaluation through dye disappearance and irrigation tests, slit lamp exams and diagnostic probing. They also defined obstruction of proximal LDS as the presence of punctal stenosis, while obstruction of distal LDS was defined as canalicular blockage and complete or incomplete nasolacrimal duct obstruction.

The investigators found a higher rate of LDS obstruction in the PXS group compared with the controls (21% vs. 12%), although the difference was not statistically significant.

On the other hand, they noted a statistically significant difference when comparing the rates of proximal LDS obstruction between the two groups: 18% in the PXS group vs. 10% in healthy individuals. Additionally, they observed more punctal stenosis in the PXS group than the controls (15% vs. 8%).

Also of note: the prevalence of canalicular stenosis and obstruction of distal LDS was similar in the PXS group and the controls.

Considering other factors, the investigators found a moderate correlation between age and punctal stenosis in the PXS group, mirroring previous studies.

Eroglu FC, Sederoglu MA, Ceran TH, et al. Evaluation of lacrimal drainage system in Pseudoexfoliation syndrome. Eye (Lond). October 13, 2021. [Epub ahead of print].