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Lid Lump of the week

15 May 2022

A 78 year old lady had had this lesion in the are of her left superior punctum for a few months. She described the lesion as ‘coming to a head’ and emitting some discharge from time to time and then reforming.

On examination the lesion looked to be overlying the punctal opening. We proceeded with excision of the lesion under local anaesthetic. The procedure exposed the punctum and a large amount of purulent discharge as well as some dacryoliths (semi solid ‘casts’) were expressed. We proceeded to a canaliculotomy (an incision to open up the first few millimetres of the caniculus to allow all of the occluded materials to be removed. Histopathological examination of the lump found it to be inflammatory tissue, without evidence of malignancy.

Trapped discharge and ‘stones’ (dacryoliths) in the canaliculus is called canaliculitis. The material is typically infected with a bacteria called actinonmyces which is associated with chronic infection. Canaliculitis can cause the punctum to be come ‘out-turned’ like an outie belly button! This is given the name a ‘pouting punctum’. Therefore this ‘lesion’ was in fact probably an extreme variant of the pouting punctum and comprised inflamed, prolapsed punctal epithelial (lining) tissue.

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